Principles and Techniques of Eyelid Reconstruction

Bernardini, Francesco P.; Skippen, Brent

doi:10.1007/978-3-030-18757-6_4

Cited by 5 publications

(10 citation statements)

References 43 publications

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“…Although the Mustardé flap ensures globe protection, complications such as lower eyelid malposition, including ectropion and entropion, and flap fibrosis can arise because of its inherent design. 3,4,8,10 The author had previously performed the described procedure for full-thickness defects involving >50% to 75% of the horizontal length of the medial and central lower eyelid. This was performed using a 1-stage technique that combined the original Mustardé flap with free grafts, such as the palatal mucoperiosteal and conchal cartilage grafts.…”

Section: Discussionmentioning

confidence: 99%

“…In terms of morbidity, the eyelashes in the flap are lost, and the flap edge may be persistently erythematous. [1][2][3][4]9,10 The original Mustardé flap, primarily a vascularized anterior lamellar flap, is designed to reconstruct significant full-thickness lower eyelid defects, affecting >50% of the horizontal length. It involves a subciliary incision that extends laterally, upward, and downward to the preauricular area.…”

Section: Discussionmentioning

confidence: 99%

“…Full-thickness defects <30% of the horizontal length of the lower eyelid can typically be closed directly. For defects involving 30% to 50% of the horizontal length, direct closure using lateral cantholysis or a semicircular Tenzel flap is possible 2,4,5,9 . In contrast, various surgical techniques can be used for defects involving 50% to 75% of the horizontal length of the medial and central lower eyelid.…”

mentioning

confidence: 99%

“…In contrast, various surgical techniques can be used for defects involving 50% to 75% of the horizontal length of the medial and central lower eyelid. These techniques range from 1- and 2-stage methods to combined approaches involving both flap and free grafting 1–12 …”

mentioning

confidence: 99%

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Modified Mustardé and Superolateral Periosteal Flaps for Full-Thickness Defects of Medial and Central Lower Eyelid

Ongkasuwan

2024

Ann Plast Surg

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Background Reconstructing full-thickness defects involving 50% to 75% of the horizontal length of the lower eyelid after medial and central full-thickness block resection can be challenging. As a disadvanatge, 1-stage reconstructions may require a free graft reconstruction of the posterior lamella. In addition, 2-stage reconstructions are associated with several complications, including erythema, and the eye must be temporarily closed after surgery. Methods The present study describes a single-surgeon retrospective case series. Five patients diagnosed with basal cell carcinoma underwent wide full-thickness block resection with optimal excision margins (3–5 mm). Subsequently, 1-stage reconstruction was performed using the modified Mustardé flap, incised using the transconjunctival approach. This flap comprised the skin, muscle, tarsus, and conjunctival flap raised from the lateral canthus through a lateral cantholysis procedure, and then extended to the lateral cheek. The flap was medially transposed to cover the medial and central lower eyelid defect. The superolateral periosteal flap was harvested from the superolateral orbital rim attached to the lateral border of the tarsus of the modified Mustardé flap. The lateral forniceal conjunctiva was released from the retractor and advanced superiorly to cover the inner surface. Results The study included 3 men and 2 women, with a mean age of 71 years (range, 62–90 years). Histological evaluations confirmed tumor-free margins in all cases. The average follow-up duration was 20 months (6–60 months), with no tumor recurrence. None of the patients developed long-term complications, such as ectropion, entropion, lagophthalmos, trichiasis, symblepharon, erythema, wound dehiscence, or flap necrosis. All patients had minimal scarring, and no secondary surgical interventions were necessary. Conclusions This case series demonstrates the efficacy of the combined modified Mustardé and superolateral periosteal flaps in 1-stage reconstruction of full-thickness defects involving 50% to 75% of the horizontal length of the medial and central lower eyelid without compromising functional and aesthetic outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Modified Mustardé and Superolateral Periosteal Flaps for Full-Thickness Defects of Medial and Central Lower Eyelid

Ongkasuwan

2024

Ann Plast Surg

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“…The correct options include: (1) anterior graft + posterior flap; OR (2) anterior flap + posterior graft; OR (3) anterior + posterior flap. 5…”

Section: Discussionunclassified

Reconstruction of Lower Eyelid with Nasolabial Flap for Anterior Lamella and Turnover Flap for Posterior Lamella

Malviya¹,

Goyal²,

Bansal³

2022

Surg J (N Y)

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Reconstruction of full-thickness eyelid defects is done to provide a mobile lid with corneal protection, having good aesthetic quality, and acceptable donor site morbidity. Various flap procedures have been described and used for the lower eyelid reconstruction; however, the nasolabial flap is rarely employed. It is a random pattern cutaneous flap with redundant blood supply from the perforating branches of the facial and angular arteries and can be used as an inferiorly or superiorly based flap. Here, we aim to present the clinical results of using the superiorly based nasolabial island flap for reconstruction of anterior lamella and turnover/hinge flap of infraorbital skin and palpebral conjunctiva with support of conchal cartilage for reconstruction of posterior lamella for lower eyelid defect. To our best knowledge, this reconstructive combination of flaps has not been described previously for total and full-thickness posttraumatic defect of lower eyelid.

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The use of the paramedian forehead flap alone or in combination with other techniques in the reconstruction of periocular defects and orbital exenterations

Ang

Juniat

O’Rourke

et al. 2022

Eye

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Purpose The paramedian forehead flap (PMFF) is a reconstructive option for large eyelid defects and orbital exenterations. We report a series of cases where PMFF reconstruction was carried out at various institutions in Australia. Methods This study was a multi-centre, retrospective, non-comparative case series investigating the clinical outcomes of the PMFF for reconstructing periocular defects and orbital exenterations. Results This case series describes twenty-seven patients (Female = 15, Male = 12), operated between 1991 to 2019, with a median age of 81 years (range: 45–93 years). Defect locations involved combinations of the medial canthus (16/27, 59.3%), upper eyelids (7/27, 25.9%), lower eyelid (4/27, 14.8%), both upper and lower eyelids (5/27, 18.5%), and orbital (7/27, 25.9%). There were no cases of flap necrosis. Minor post-operative complications were observed in ten patients with the most common being lagophthalmos. Median duration of follow-up was 17months (Range: 2months- 23years). Conclusions The PMFF is a versatile reconstructive tool for a range of periocular defects and orbital exenterations with minor post-operative complications.

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Principles and Techniques of Eyelid Reconstruction

Cited by 5 publications

References 43 publications

Modified Mustardé and Superolateral Periosteal Flaps for Full-Thickness Defects of Medial and Central Lower Eyelid

Modified Mustardé and Superolateral Periosteal Flaps for Full-Thickness Defects of Medial and Central Lower Eyelid

Reconstruction of Lower Eyelid with Nasolabial Flap for Anterior Lamella and Turnover Flap for Posterior Lamella

The use of the paramedian forehead flap alone or in combination with other techniques in the reconstruction of periocular defects and orbital exenterations

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