A useful flap combination in wide and complex defect reconstruction of the medial canthal region: Glabellar rotation and nasolabial V-Y advancement flaps

Kesiktaş, Erol; Eser, Cengiz; Gencel, Eyüphan; Aslaner, Emrah Efe

doi:10.4172/plastic-surgery.1000910

Cited by 4 publications

(12 citation statements)

References 14 publications

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“…Postoperative epiphora rates were calculated based on this. From these studies, the median epiphora rate was 12.5% (range 0%–100%) 10–12 14–29. The 100% was from a case report with a single patient.…”

Section: Resultsmentioning

confidence: 98%

“…Lacrimal system reconstruction following medial canthal tumour resection is not well studied. The majority are case series or a small subset of patients in larger retrospective cohort studies that examine either a specific reconstructive method to the skin and medial canthal area or lacrimal system obstruction due to a variety of causes 10–16. Marsupialisation of the remnant canaliculus is a relatively straightforward procedure.…”

Section: Introductionmentioning

confidence: 99%

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Holding back the tears: is there a role for marsupialisation?

2022

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ObjectiveMedial eyelid tumours may result in the loss of the proximal lacrimal system during staged excision and delayed reconstruction, to achieve tumour margin clearance. The remnant canaliculus was marsupialised during reconstruction. The aim was to understand how many patients experienced symptomatic epiphora as a consequence of this.Methods and analysisA retrospective study including patients over a 15-year period with medial eyelid tumours, where the proximal lacrimal system was sacrificed to achieve tumour margin clearance. Included were all who had marsupialisation of the remnant distal stump as part of their delayed reconstruction. All who had pre-existing epiphora were excluded. The primary objective was the rate of epiphora following the procedure. A systematic literature review of postoperative epiphora occurring in patients with lid tumours requiring lacrimal system injury/sacrifice during tumour excision.ResultsThere were 22 eyes (22 patients). All were basal cell carcinomas except for 1 (4.5%) tarsal conjunctival squamous cell carcinoma. All cases involved the lower lid. There were two (9.1%) patients who developed epiphora. One patient underwent a superior three-snip punctoplasty, botulinum toxin to the lacrimal gland and conjunctivodacryocystorhinostomy with Lester Jones tube insertion. The other patient was not overly troubled and did not require further treatment. The literature review showed the median postoperative rate of epiphora in these patients was 12.5% (range 0%–100%).ConclusionMarsupialisation of the remnant canaliculus during delayed reconstruction is a straightforward and effective surgical option, which may help prevent postreconstruction epiphora when the proximal lacrimal system is sacrificed for tumour margin clearance.Trial registration number10391.

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Section: Resultsmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Holding back the tears: is there a role for marsupialisation?

2022

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“…16 However, besides a prolonged healing time and meticulous wound care, disadvantages also include overcontraction with distortion, ectropion formation, medial canthal webbing, trichiasis, eyelid notching, and hypertrophic scarring. 4,17 However, secondary healing can be considered in small and superficial defects especially in elderly patients.…”

Section: Discussionmentioning

confidence: 99%

“…Hence, in reconstruction of the medial canthal region local flaps, using neighboring tissue should be the first choice to achieve natural appearance, color, and tissue harmony. 4 The classical rhomboid flap is a useful surgical technique to cover defects created by simple excisions in the shape of a rhombus and seems to be well suited for reconstruction in the periorbital area. 6 The aim of our study was to describe a new technique for reconstruction of medial canthal defects using a modified rhomboid flap.…”

Section: Introductionmentioning

confidence: 99%

A Modified Rhomboid Flap for Medial Canthal Reconstruction

Tasch

Pattiss

Lanthaler

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Background:The reconstruction of medial canthal defects is often challenging in achieving continuity of color and texture, obtaining adequate tissue for large defects, and the reproduction of natural external appearance with inconspicuous scars. We describe a technique for reconstruction of the medial canthal area, using a modified rhomboid flap. Methods:The technique is based on the use of a modified rhomboid flap for medial canthal defects-superiorly based on the root of the nose for defects mostly above the medial canthal tendon, inferiorly based on the cheek for defects mostly below the medial canthal tendon, and in cases of large defects, using a combination of the two flaps. We present a case series of five patients successfully reconstructed with the mentioned technique after resection of medial canthal basal cell carcinoma. Results: Of the five patients with a mean age of 76.2 years (range 62-84 years), reconstruction was performed in three patients with a superiorly based rhomboid flap, in one patient with an inferiorly based rhomboid flap, and in another patient with a large defect using a combination of the two flaps. Mean follow-up was 374.4 days (range 30-1247 days). All patients achieved a complete primary closure with no further surgery and satisfactory cosmetic and functional results. Conclusion:The modified rhomboid flap is a simple and reliable technique for all defects of the medial canthal area.

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“…The V–Y flap requires less dissection and operation time, but advancement of the flap results in a vertical scar across the relaxed skin tension line, which can cause postoperative ectropion, especially on the lower eyelid. This flap has been modified to follow a horizontal orientation to minimize the risk of postoperative lower lid mispositioning [ 17 – 19 ].…”

Section: Anterior Lamellar Defectsmentioning

confidence: 99%

Surgical Strategies for Eyelid Defect Reconstruction: A Review on Principles and Techniques

Yan

et al. 2022

Ophthalmol Ther

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Reconstruction of eyelid defects, especially the posterior lamella, remains challenging because of its anatomical complexity, functional considerations, and aesthetic concerns. The goals of eyelid reconstruction include restoring eyelid structure and function and achieving an aesthetically acceptable appearance. An in-depth understanding of the complex eyelid anatomy and several reconstructive principles are mandatory to achieve these goals. Currently, there are multiple surgical treatment options for eyelid reconstruction, including different flaps, grafts, and combinations of them. This comprehensive review outlines the principles of reconstruction and discusses the indications, advantages, and disadvantages of currently available surgical techniques. We also propose our clinical thinking for solving specific clinical questions in eyelid reconstruction and offer perspectives on new potential methodologies in the future.

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A useful flap combination in wide and complex defect reconstruction of the medial canthal region: Glabellar rotation and nasolabial V-Y advancement flaps

Cited by 4 publications

References 14 publications

Holding back the tears: is there a role for marsupialisation?

Holding back the tears: is there a role for marsupialisation?

A Modified Rhomboid Flap for Medial Canthal Reconstruction

Surgical Strategies for Eyelid Defect Reconstruction: A Review on Principles and Techniques

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