Transcript Direct Closure

EYELID RECONSTRUCTION
AN OVERVIEW
EYELID RECONSTRUCTION
AIMS
MAINTAIN FUNCTION &
INTEGRITY OF PERIORBITAL
STRUCTURES
ACHIEVE OPTIMAL COSMESIS
EYELID RECONSTRUCTION
GOALS
• SMOOTH MUCOSA-LIKE INTERNAL LINING
• STABLE EYELID MARGIN WITH LASHES PROJECTING
AWAY FROM THE GLOBE
• LID RIGIDITY OF THE TARSAL AND CANTHAL AREAS
• FUNCTIONAL RETRACTORS
• ADEQUATE CLOSURE FOR PROTECTION AND
LUBRICATION
• ACCEPTABLE COSMESIS
EYELID RECONSTRUCTION
–ANATOMY
 EYELID POSITION HALFWAY BETWEEN PUPIL
& LIMBUS – NORMAL EXCURSION 16MM
 CANTHAL POSITION - LATERAL AGAINST
GLOBE
 MEDIAL, SEPARATION BY LACRIMAL
CARUNCLE
EYELID ANATOMY
LATERAL ANGLE 2-3MM HIGHER THAN
THE MEDIAL CANTHAL AREA
EYELIDS TWO LAMELLA
ANTERIOR - SKIN AND MUSCLE,
POSTERIOR - CONJUNCTIVA
TARSAL PLATE
LID RETRACTORS
EYELID ANATOMY
LID MARGIN 2MM THICK
ANTERIOR EYELASHES
 POSTERIOR MEIBOMIAN GLAND
ORIFICES
GREY LINE SEPERATES TWO AREAS
EYELID ANATOMY
PUNCTUM
 INFERIOR TYPICALLY 2MM LATERAL TO
SUPERIOR
BLOOD SUPPLY
 MARGINAL ARTERY 3-4MM FROM MARGIN
LACRIMAL SYSTEM
• LACRIMAL GLAND
• LACRIMAL DRAINAGE SYSTEM
PUNCTA UPPER AND LOWER CANALICULI
LACRIMAL SAC AND NASO-LACRIMAL
DUCT
PREPARATION
GLOBE PROTECTION
LUBRICATION
CORNEAL PROTECTOR
SUTURE PLACEMENT
ANAESTHESIA –
 LOCAL, GENERAL, TOPICAL
WOUND PREPARATION –
 MINIMAL DEBRIDEMENT
DEFECTS
UPPER
LOWER
DO NOT USE UPPER LID FOR LOWER
LID DEFECTS
LOWER LID DEFECTS
PARTIAL
FULL THICKNESS
LOWER LID DEFECTS
PARTIAL –
 PRIMARY CLOSURE
 FLAPS
FULL THICKNESS GRAFT
Direct Closure
PRIMARY CLOSURE
VERTICAL NOT HORIZONTAL
PENTAGONAL= NO NOTCH
FULLTHICKNESS GRAFT
UPPER LID
EXCESS SKIN
POST AURICULAR
 ? 2 SSG
PRE AURICULAR
THICKER & LIMITED
SUPRACLAVICULAR
 THICKER, COLOUR MATCH NOT
FLAPS
VY
FROM CHEEK
TRANSPOSITION
GLABELLA, NASOLABIAL,
EYELID OR BROW
ROTATION ADVANCEMENT
CHEEK
LOWER LID DEFECTS
• FULL THICKNESS
• EXTENSILE APPROACH
• ¼ TO 1/3
– COMPOSITE GRAFT FROM OPPOSITE LID,
• UP TO 50%.
– LATERAL CANTHOTOMY
• GREATER THAN 50%
– CHEEK ROTATION OR VY FLAP AND
MUCOCHONDRAL GRAFT
LOWER LID DEFECTS
• FULL
THICKNESS
• EXTENSILE
APPROACH
LOWER LID DEFECTS
• FULL
THICKNESS
• EXTENSILE
APPROACH
LOWER LID DEFECTS
• FULL
THICKNESS
• EXTENSILE
APPROACH
LOWER LID DEFECTS
• FULL
THICKNESS
• EXTENSILE
APPROACH
LOWER LID DEFECTS
• FULL
THICKNESS
• EXTENSILE
APPROACH
LOWER LID DEFECTS
•FULL THICKNESS
NB
? NEED FOR MUCOUS LINING IN LOWER LID
DEFECTS.
SOURCE OF CHONDROMUCOSAL GRAFT
UPPER LID DEFECTS
- PARTIAL THICKNESS
-
DIRECT CLOSURE
LOCAL FLAP
FTG FROM OTHER LID
DISTANT FLAP
- TEMPLE FLAP
UPPER LID DEFECTS
- FULL THICKNESS
- SIMILAR CONSIDERATIONS TO LOWER
EYELID.
UPPER LID DEFECTS
- FULL
THICKNESS
- SIMILAR
CONSIDERATIONS
TO LOWER EYELID.
UPPER LID DEFECTS
- FULL
THICKNESS
- SIMILAR
CONSIDERATIONS
TO LOWER EYELID.
UPPER LID DEFECTS
- FULL
THICKNESS
- SIMILAR
CONSIDERATIONS
TO LOWER EYELID.