Efficacy of lateral eyelid‐block excision with canthoplasty and full‐thickness skin grafting in lower eyelid cicatricial ectropion

Abstract

Purpose To report on the outcomes of our preferred surgical technique for the correction of lower eyelid cicatricial ectropion Methods We conducted a retrospective, nonrandomized, interventional analysis of a consecutive case series of patients with cicatricial lower lid ectropion treated with adhesiolysis, lateral eyelid‐block excision with canthoplasty and full‐thickness skin grafting. Donor sites included the ipsi‐ or contralateral upper eyelid and pre‐ or retroauricular skin. All patients were treated by one of our oculoplastic surgeons in the period from January 2005 to January 2017 in the Rotterdam Eye Hospital/Focus Clinic Rotterdam. We assessed postoperative lower eyelid apposition, the occurrence of intra‐ and postoperative complications and the reoperation rate. Results We included 38 eyelids of 32 patients, of whom 17 were male and 15 were female. The minimal postoperative follow‐up was 3 months. A total of 27 of 38 eyelids showed good postoperative apposition. Skin graft donor sites were the ipsi‐ or contralateral upper eyelid (47% and 16%, respectively) and the pre‐ or retroauricular skin (26% and 11%, respectively). No intraoperative complications occurred, but one patient developed a transient allergic contact dermatitis in the early postoperative phase. Two of 38 eyelids (two of 32 patients) required another surgical intervention (block excision) for residual or recurrent ectropion, with favourable outcomes. There was 100% viability of the skin grafts. Conclusion Repair of lower eyelid ectropion with lateral block excision, canthoplasty and full‐thickness skin grafting is an effective procedure with minimal donor site morbidity, excellent graft survival rates and a low reoperation rate.

Management of Severe Multifactorial Eyelid Ectropion With Lateral Tarsal Strip Procedure and Full-Thickness Skin Graft

“…Similar aim is achieved with lateral eyelid-block excision with canthoplasty and FTSG. This technique develops a horizontal myocutaneous flap along the entire lower eyelid margin [ 9 ]. The flap is advanced laterally until the appropriate lid tone is restored.…”

“…The flap is advanced laterally until the appropriate lid tone is restored. Then, the lateral end of the flap is reattached to the lateral canthal ligament followed by the use of FTSG to manage the shortage of eyelid skin [ 9 ]. Interestingly, the Bick’s procedure or resection of the lateral aspect of the lower eyelid without disrupting the lateral canthal tendon appeared as a quick and easy surgical refinement to exclusively manage horizontal laxity.…”

Clinical features, surgical outcomes and genetic analysis of ectodermal dysplasia with ocular diseases

“…They lack healthy skin for transplantation, and there is a high possibility of contracture and poor healing of the grafting skin flap, which can easily lead to flap necrosis and recurrence of ectropion. There are reports citing the use of autografts from the arm, ipsi-or contralateral eyelid [23] , re-auricular or retro-auricular region, groin or penile foreskin in males [19] , human-engineered skin, mucous membrane grafts and maternal skin grafts (which require human leukocyte antigen typing and carry the risk of graft rejection) for reconstructing the eyelid skin [24][25] . According to the patients' skin condition, the surgeon should select relatively normal skin to repair eyelid defects.…”

Surgical Correction of Ectropion: Comparison Between Full Thickness Skin Grafts and Local Flaps

“…Proportions of patients with recurrent ectropion treated with full-thickness skin graft=24%. 10 Proportions of patients with recurrent ectropion treated with local flap=0%. 11 Therefore, at a 95% confidence interval and power of 80%, a sample of 28 patients was calculated.…”