Transcript Optimizing the Periosteal Flap for Lateral Eyelid

Optimizing the Periosteal Flap
for
Lateral Eyelid Reconstruction
W. Thomas McClellan, M.D., WVU
Clinton McCord, M.D., Emory
Rebecca Neusch, WVU
Nothing to Disclose
Objective of the Study
To establish a standardized
method
to
harvest
the
periosteal flap in order to
improve
eyelid
strength,
position, and reduce ectropion.
Materials and Methods - Design
 Create
a central meridian from the
upper puncta to the lateral orbital rim.
 This intersection point is where the
superior aspect of the flap is started
and continues at a 40 degree angle
superiorly out a distance X (which is
the length needed to repair the
defect).
Materials and Methods - Design
Materials and Methods - Design
 The
width of the flap should measure
6-7 mm which compensates for
primary contracture while maintaining
strength of the periosteum. The
periosteum is then secured with 5-0
Vicryl to the lateral edge of the tarsal
plate with enough tension that the
lid approximates the globe.
Materials and Methods - Design
 If
the flap is extended onto the
temporalis fascia up to 50% of
the posterior lamella of the lower
eyelid can potentially be closed.
Materials and Methods
 Once
the flap is secured, a
Tenzel flap can be rotated to
repair the anterior lamellar defect
and sutured with 6-0 nylon and 5-0
plain gut near the line margin.
 Sutures are removed at 6 days.
Surgical Images
Figure 1 Pre-Op 80% lower
eyelid + canthal Defect
Figure 2 Intra-Op periosteal
flap dissection
Surgical Images
Figure 3 Periosteal flap reflected to bridge the
posterior lamellar defect
Post-Operative Images
Figure 4 Post-Operative
Frontal View
Figure 5 Post-Operative
Oblique View
Results and Conclusions
 12
patients all with good outcomes
 There
were no complications such
as canthal dehiscence, cicatrical
ectropion or entropion.
Results and Conclusion
 The
periosteal flap is an ideal flap to
repair the lateral canthus and lateral
posterior lamella due to its simplicity,
reliability, and low risk.
Results and Conclusion
 It
can be designed to match the
native eyelid contour, originates
within the lateral orbit, is strong, and
highly vascular2. Additionally if the
flap relaxes with time it can be
elevated and re-secured within the
lateral orbit.
Significance of the Findings
This
standardized
method
demonstrates a reliable method of
reconstructing
lateral
eyelid
defects. It optimizes lid position
and reduces post operative
ectropion.
References
1. Smith, B.C., Nesi, F.A. Practical Techniques
in Ophthalmic Plastic Surgery. St. Louis: The
C.V. Mosby Company, 1981. Pp. 92-95.
2. Weinstein GS, Anderson RL, Tse DT,
Kersten RC. The use of a periosteal strip for
eyelid reconstruction. Arch. Ophthalmol. 1985
Mar;103(3):357-359.
3. McCord, C.D. Jr., Codner, M.A. Eyelid and
Periorbital Surgery, Vol.2, 1st Ed. St. Louis:
Quality Medical Publishing, Inc., 2008. Pp.
600.