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Klin Monbl Augenheilkd 2018; 235(04): 398-403
DOI: 10.1055/s-0043-122736
Klinische Studie
Georg Thieme Verlag KG Stuttgart · New York

Eyelid Reconstruction: Pediculated versus Non-Pediculated

Lidrekonstruktion: gestielte versus freie Transplantate
Sonja Frimmel
Department of Ophthalmology, University Hospital Zürich, Zürich, Switzerland
,
Christoph Kniestedt
Department of Ophthalmology, University Hospital Zürich, Zürich, Switzerland
,
Karla Chaloupka
Department of Ophthalmology, University Hospital Zürich, Zürich, Switzerland
› Author Affiliations
Further Information

Publication History

received 20 September 2017

accepted 08 November 2017

Publication Date:
19 January 2018 (online)

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Abstract

Background To compare the functional and cosmetic outcome of pediculated versus free anterior and posterior lamella reconstruction after large eyelid defects due to malignancy excision.

Patients and Methods A retrospective study over 2 years with 12 patients matching the criterion of pediculated versus non-pediculated transplants out of a cohort of 124 tumor excisions. The mean age was 76 ± 8 years of the 7 male and 5 female patients. In the majority of cases, more than half of the eyelid was excised. The posterior lamella was always reconstructed with tarsal tissue, and the anterior lamella mostly with an upper eyelid skin graft. The postoperative follow-up time was between 2 months and 1 year.

Results Nodular basal cell carcinoma was the prevailing histology (6 patients). The reconstruction techniques included a Hughes procedure (four patients) or a free tarsal graft with a pediculated skin flap (four patients), respectively. In the remaining four patients, a combination of pediculated/free anterior AND posterior lamellae was performed. Four patients had a one-stage and eight patients a 2nd stage procedure with a mean time until tarsoconjunctival flap reopening of 16 ± 2 days.

Conclusions No difference was found in the final functional outcome in pediculted versus free grafts. The cosmetic result was better in anterior lamella reconstructions with a pediculated flap, which usually allows a one-stage procedure. The 2nd stage procedure could be performed after 2 weeks without any complications.

Zusammenfassung

Hintergrund Größere durchgreifende Liddefekte nach Tumorexzisionen können mittels verschiedener Techniken rekonstruiert werden, wobei zumindest eine Lamelle perfundiert (gestielt) sein muss. Wir vergleichen das funktionelle und kosmetische Resultat von gestielten versus freien Transplantaten der rekonstruierten anterioren respektive posterioren Lidlamellen.

Patienten und Methoden Retrospektive Studie über 2 Jahre mit 12 Patienten (7 Männer, 5 Frauen). Durchschnittsalter war 76 ± 8 Jahre. Es wurde meist mehr als die Hälfte des Lids entfernt. Die posteriore Lamelle wurde immer mit Tarsusgraft rekonstruiert, die anteriore meist mit der Haut vom Oberlid. Die postoperative Follow-up-Zeit betrug 2 – 12 Monate.

Ergebnisse Das noduläre Basalzellkarzinom kam am häufigsten vor (6 Fälle). Zur Rekonstruktion der Augenlider wurden folgende Methoden angewandt: Hughes Flap (4×), freier Tarsusgraft mit gestieltem Hautlappen (4×) und eine Kombination aus gestielten/freien anterioren und posterioren Lamellen (4×). Vier Patienten konnten einzeitig operiert werden, 8 Patienten bedurften eines zweizeitigen Vorgehens mit einer durchschnittlichen Verschlusszeit der tarsokonjunktivalen Brücke von 16 ± 2 Tagen.

Schlussfolgerungen Das funktionelle Resultat zeigte keinen Unterschied zwischen gestielten und freien Transplantaten. Das kosmetische Resultat war besser bei gestielter Rekonstruktion der kutanen, anterioren Lamelle, was meist auch einen einzeitigen Eingriff ermöglicht. Alle gestielten tarsokonjunktivale Flaps konnten problemlos nach 2 Wochen eröffnet werden.

Key words

eyelid reconstruction - Hughes procedure - pediculated flap - free skin graft - malignancy

Schlüsselwörter

Lidrekonstruktion - Hughes Flap - gestielter Lappen - freies Hauttransplantat - Malignität
 

  • References

  • 1 Cook jr. BE, Bartley GB. Treatment options and future prospects for the management of eyelid malignancies: an evidence-based update. Ophthalmology 2001; 108: 2088-2098 quiz 2099–2100, 2121
    CrossrefPubMedGoogle Scholar
  • 2 Hintschich C. Periocular plastic surgery. Dtsch Arztebl Int 2010; 107: 141-146
    PubMedGoogle Scholar
  • 3 Cook jr. BE, Bartley GB. Epidemiologic characteristics and clinical course of patients with malignant eyelid tumors in an incidence cohort in Olmsted County, Minnesota. Ophthalmology 1999; 106: 746-750
    CrossrefPubMedGoogle Scholar
  • 4 Hughes WL. Reconstructive surgery of the eyelids. Adv Ophthalmic Plast Reconstr Surg 1986; 5: 25-87
    PubMedGoogle Scholar
  • 5 Marcet MM, Lau IHW, Chow SSW. Avoiding the Hughes flap in lower eyelid reconstruction. Curr Opin Ophthalmol 2017; 28: 493-498
    CrossrefPubMedGoogle Scholar
  • 6 Tenzel RR, Stewart WB. Eyelid reconstruction by the semicircle flap technique. Ophthalmology 1978; 85: 1164-1169
    CrossrefPubMedGoogle Scholar
  • 7 Mustarde JC. The use of flaps in the orbital region. Plast Reconstr Surg 1970; 45: 146-150
    CrossrefPubMedGoogle Scholar
  • 8 McNab AA. Early division of the conjunctival pedicle in modified Hughes repair of the lower eyelid. Ophthalmic Surg Lasers 1996; 27: 422-424
    PubMedGoogle Scholar
  • 9 McNab AA, Martin P, Benger R. et al. A prospective randomized study comparing division of the pedicle of modified Hughes flaps at two or four weeks. Ophthal Plast Reconstr Surg 2001; 17: 317-319
    CrossrefPubMedGoogle Scholar
  • 10 Hawes MJ, Grove jr. AS, Hink EM. Comparison of free tarsoconjunctival grafts and Hughes tarsoconjunctival grafts for lower eyelid reconstruction. Ophthal Plast Reconstr Surg 2011; 27: 219-223
    CrossrefPubMedGoogle Scholar
  • 11 Perry CB, Allen RC. Repair of 50–75 % full-thickness lower eyelid defects: lateral stabilization as a guiding principle. Indian J Ophthalmol 2016; 64: 563-567
    CrossrefPubMedGoogle Scholar