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 AS
GOOD
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 CHONDRO- MUCOSAL 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.