Superiorly based nasolabial island flap for reconstruction of the lateral lower eyelid

Abstract

IntroductionReconstruction of the eyelids is a challenging task for plastic and reconstructive surgeons and is mostly performed due to trauma, tumor resection, or, less commonly, congenital abnormalities (e.g., coloboma, Tessier no. 3-6 clefts) (1,2). The decision as to the most appropriate reconstructive option depends on assessment of the eyelid defect in terms of its size, extent, orientation, and, most importantly, location. A method of classifying periocular defects according to location was developed by Spinelli and Jelks (3), in which the eyelid was divided into 5 zones: zone I, the upper eyelid; zone II, the lower eyelid; zone III, the medial canthal region; and zone IV, the lateral canthal region. Furthermore, any area outside zones I-IV but contiguous with the eyelids was described as zone V in this classification system (Figure 1).Full-thickness defects up to 25% of the width of the lower eyelid can be repaired via direct closure. Lateral canthotomy and cantholysis can provide 25% additional horizontal length, leading to tissue advancement and rotation to aid in closure of larger defects (1,3,4). When primary closure is not feasible, various flap alternatives developed with the aims of functional restoration and aesthetic improvement of the lower eyelid zones can be employed, such as the semicircle (Tenzel) flap ( 5), superiorly based tarsoconjunctival advancement (Hughes) flap (6), upper eyelid myocutaneous (Tripier) flap (7), transposed cheek (McGregor) flap (8), cheek rotation and advancement (Mustardé) flap (9), and supraorbital (Fricke) flap (10).Nasolabial flap is rarely employed for the reconstruction of the lower eyelid. 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 (11,12). It has a wide spectrum of use for nasal and midfacial defects (13,14) and can be used as an island (15) or transposition flap (16-18) for the reconstruction of the lower eyelid.In this study, we aimed to present the clinical results of using the superiorly based nasolabial island flap for repair Background/aim: Various flap procedures have been described and used for the lower eyelids; however, the nasolabial flap is rarely employed. We herein aimed to present the clinical results of using the superiorly based nasolabial island flap for repair of surgical defects extending to the lateral lower eyelid. Materials and methods:Nine patients with a mean age of 62 ± 6 years underwent surgery for reconstruction of the lower eyelid. Results:The diagnosis of lesions was nodular basal-cell carcinoma (n = 5), superficial basal-cell carcinoma (n = 1), well-differentiated squamous-cell carcinoma (n = 1), and basosquamous-cell carcinoma (n = 2). According to the classification reported by Spinelli and Jelks, 6 surgical defects were located at zones II and IV, while 3 were at zones II and V. Five patients required posterior lamellar reconstruction. Lagopthalmos (n = 1), ectropion (n = 1), and trans...

Effects of Baihe Dihuang powder on chronic stress depression rat models

“…Studies have shown that there is immune activation in patients with depression. Thymus and spleen are two important immune organs in the body (Wan et al, 2017, Tong, 2014, Naveed et al, 2018, Babenko et al, 2017, Pati et al, 2017, Tatar et al, 2017, Peng et al, 2017, Gao et al, 2017). The pathological changes of spleen and thymus in chronic stress depression rats can be improved significantly after intervention, indicating that it can alleviate the pathological development of depression by interfering with the immune system.…”

A New Technique for Reconstruction of Medium-Sized Eyelid Defects (A Modification of Tessier Nasojugal Flap)

“…2 As a problematic complication in lower eyelid surgery, ectropion is defined as the inappropriate position of eyelids wherein the lower eyelid margin shows emerges from the globe. 1 Ectropion occurs due to excessive incision of eyelid tissue during blepharoplasty and eyelid reconstruction. 3 In addition, other factors causing ectropion include involutional laxity of the lower eyelid as well as mechanical factors such as bulkiness of the facial flaps in comparison to the adjacent anatomic structures, which results in considerable Fig.…”

“…Eyelid reconstructions can be considered as the most challenging surgical procedure and are mostly done due to trauma, tumor resections, and congenital defects. 1 Optimization of aesthetic and functional outcomes is a general goal in the reconstruction of eyelid defects. Overall, eyelid reconstruction must follow basic principles so that the surgeon should use conventional methods for reconstruction before thinking about more complex methods.…”

“…2 When direct closure is impossible, different alternatives with the goal of saving function and improving aesthetic features in different locations of the eyelid will be considered. 1 In the defects of lower eyelid involving one-third to half of the eyelid margin, lateral edge advancement of the eyelid by approximation method of semicircular or by rotational flap will be done. 2 In patients with full-thickness defects, the defect size and laxity in the periocular tissue are important determinants for best reconstruction results or combinatory reconstruction methods.…”

“…However, nasolabial flaps have been rarely used for lower eyelid defects. 1 In this study, we have introduced a modified form of nasojugal flap to reconstruct the lower eyelid to provide a mobile lid with good cosmetic and functional effect for corneal protection without ectropion.…”