ABSTRACT
OBJECTIVE: The aim of this surgical procedure was to definitively correct severe recurrent upper and lower bilateral eyelid ectropion after 2 attempts with full-thickness skin grafts. It was necessary to repair all 4 eyelids with forehead skin. Middle lamella support was required. METHODS: Bilateral median forehead flaps, which were well vascularized by the supratrochlear vessels, were chosen for this procedure to utilize the readily available forehead tissue. The median forehead flap can be easily positioned to cover the entire eyelid. Furthermore, the flap could be split in half, without the risk of vascular compromise. Middle lamella support was provided with a cartilage graft from the nasal septum. RESULTS: At 4 months, the patient no longer suffered from exposure keratopathy and both forehead flaps had healed well. At 12 months, the functional and cosmetic outcomes of this procedure were acceptable. CONCLUSIONS: This method of surgery can be effective in the young, in whom the Mustarde cheek advancement fails, or when there is little available unburnt tissue. It can be used as an alternative to a forehead flap when both upper and lower eyelids are damaged bilaterally. The split forehead flap definitively corrected the ectropion in this case.
ABSTRACT
BACKGROUND: Successful skin grafting requires multiple factors for success. An even distribution of constant pressure exerted upon the graft is necessary for successful graft take. It is well known that excessive pressure on a graft causes ischemia and may result in the failure of graft take. The aim of this study was to demonstrate the variation in skin pressure (tension) on curved surfaces, particularly relating to apical pressure on such surfaces at standard atmospheric pressure. METHODS: A synthetic Sawbone skull model was used to determine skin tension over a curved surface. A 10-cm diameter circle was centered on the parietal eminence, the area of maximum curvature. Peripheral screws gave fixed reproducible points to secure the foam dressing. Open-cell VAC dressing foam was used and calibrated Tekscan sensors were used to determine pressure variation under the foam dressing. RESULTS: Five hundred pressure readings were obtained for the unscored foam, and an additional 500 for the cross-scored foam. In the unscored foam, the pressure under the dressing was significantly higher at the apex. Cross-scoring the foam reduced the pressure, with the greatest reduction being at the apex. The pressure under the foam dressing was maximal at the apical point (95% confidence interval). CONCLUSION: Higher contact force at the apex of a curved graft bed may explain skin graft loss. Unequal pressure distribution can be reduced and equalized by scoring the foam.
