Upper eyelid reconstruction: a short report of an eyelid defect following a thermal burn
© Inchingolo et al; licensee BioMed Central Ltd. 2009
Received: 10 October 2009
Accepted: 25 November 2009
Published: 25 November 2009
While the principles of eyelid reconstruction are well-established, achieving good functional and aesthetic reconstruction remains challenging.
This communication presents a technique that we used on a young patient with an eyelid defect following a thermal burn. The patient was operated on to reconstruct the entire upper eyelid using, as a posterior lamella, a mucochondrial autologous graft taken from the ala of the nose as a tarsus and conjunctiva substitutes that were sutured to the Elevator palpebrae superioris aponeurosis and muscle. On the other hand, to reconstruct the anterior lamella, which consists of skin and muscle, the surgeons used a myocutaneous temporal flap taken from the region immediately lateral to the external canthus of the palpebral region, and which, after being isolated following a drawing of the upper eyelid to be reconstructed, was rotated and then sutured to the posterior lamella using the orbicularis oculi muscle as a pedicle.
While the principles of eyelid reconstruction are well-established, achieving good functional and aesthetic reconstruction remains challenging (1).
A variety of techniques are now available, depending on the type of lesion and its cause. This communication presents a technique that we used on a young patient with an eyelid defect following a thermal burn, which we recently encountered.
The 37 year-old patient from a small town in northern Italy, was welding when he was hit by a spray of liquid metal on the periorbital region that burned the upper eyelid and part of the lower eyelid. The patient was treated by eye-specialists at the local hospital with multiple debridements of the palpebral lesions, that take several weeks to heal, save for the complete loss of the upper eyelid, albeit partially maintaining the medial and lateral canthus, along with a loss of the ciliary margin of the entire lower eyelid. In the weeks which followed, the inflammation of the eyeball, which was undamaged by the metal but irritated due to a lack of palpebral protection, worsened further, partially compromising the eye's functionality. So, surgery was scheduled to reconstruct the eyelid in a single operation, because of the distance the patient had to travel, which would also provide satisfactory functional and aesthetic results. The patient was operated on to reconstruct the entire upper eyelid using, as a posterior lamella, a mucochondrial autologous graft taken from the ala of the nose as a tarsus and conjunctiva substitutes that were sutured to the levator palpebrae
We, thus, consider the possible use of the myocutaneous temporal flap as a substitute for the anterior lamella of the upper eyelid in the reconstruction of the complete eyelid to be extremely satisfactory. Thanks to the fact that the orbicularis oculi muscle beyond the orbital margins covers the surface of the frontalis, temporalis, and other muscles, this pedicle, previously mentioned by Yoshimura et al. in 1991 (2), provides the possibility of further transferring orbicularis muscle to the missing area when it is not possible to use the lower eyelid as a donor area, with skin whose characteristics are similar to those of the upper eyelid and with absolutely sure vascularization since it contains branches of the angular artery and the infraorbital artery in its pedicle. Making use of a muco-cartilaginous graft taken from the ala of the nose is also advantageous, since it reproduces the firmness and features of the posterior lamella formed by the tarsal plate and the conjunctiva, without altering either the functionality or the aesthetics of the ala of the nose.
We, therefore, believe our experiences, which can easily be reproduced in cases of total or subtotal full-thickness defects of the upper eyelid, will be of interest.
Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
- Di Francesco LM, Codner MA, McCord CD: Upper Eyelid Reconstruction. Plastic & Reconstructive Surgery. 2004, 114 (7): 98e-107e. 10.1097/01.PRS.0000142743.57711.48.View ArticleGoogle Scholar
- Yoshimura Y, Nakajima T, Yoneda K: Reconstruction of the entire upper eyelid area with a subcutaneous pedicle flap based on the orbicularis oculi muscle. Plastic & Reconstructive Surgery. 1991, 88 (1): 136-9.View ArticleGoogle Scholar
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