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DR.KEERTHANA,resident, RIO

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Published by RIOGOHMSPG, 2020-06-28 07:54:48

UPPER EYE LID RECON

DR.KEERTHANA,resident, RIO

Keywords: Lower lid recon

EYE LID
RECONSTRUCTION

PROF. DR. M.V.S.PRAKASH
PROF. DR. ASHOK KUMAR
ASST . DR. P.GEETHA
ASST.DR.UMA MAHESHWARI
ASST. DR. R.SUJATHA
DR. KEERTHANA SEMBIAN

EYELID
RECONSTRUCTION

• Aims:

– To reestablish functional eyelids
– Adequate protection of the eyeball
– Reasonable cosmesis

INDICATIONS

The eyelid defects which need
reconstructions are seen in

• congenital anomalies,
• Post trauma,
• Post excision for neoplastic

conditions.

EYELID

➢RequiremeRnts:ECONSTRUCTION

➢ Smooth mucousmembraneinternal lining to maintain lubrication of
the ocular surface and avoid cornealirritation


➢ Skeletal support toprovide adequate lid rigidity and shapebut also
allow molding to theglobe

➢ Stableeyelid margin to keep eyelashes& skin awayfromcornea

➢ Proper fixation of the medial & lateral canthal attachments of the lids for
eyelid stability &orientation

➢ Adequate levator action to lift the upper lid above the visual axis

➢ In the reconstruction of both anterior & posterior lamellae, at least one must
haveits own bloodsupply

➢ Techniqueswould depend on the size, location,configuration,& depthof the

defect

➢ Superficial defect:only anterior lamella needs to be repaired

➢ Fullthickness defect:needsreconstructionof both layers

EYELID RECONSTRUCTION

• Anterior & Posteriorlamella

Anterior lamella:

– Skin & orbicularis oculi
– Dynamic closure of upper & lower lids
– Lacrimal pump mechanism

Posterior lamella:

– Tarsal plates
– Conjunctival lining

GRAFT & FLAP

• GRAFT:
-FULL THICKNESS
- SPLIT SKIN GRAFT

FLAPS:
-FREE FLAP
-PEDICLED FLAP

• Anterior lamella:

– Flaps - advancement, transposition, or rotational
musculocutaneous flaps

– Full thickness skin grafts

• Posterior lamella:

– Tarsal-conjunctival transposition, advancement
or rotational flap

– Free autogenous composite tarsal grafts
– Tarsal substitute grafts - sclera, nasal

septal chondromucosa, hard palate
mucosa

UPPER EYELID
RECONSTRUCTION

➢Direct Closure +/- lateralcantholysis
➢ Tenzel Flap
➢SlidingTarsoconjunctival Flap.
➢Posterior Lamellar Graft with local

myocutaneous flap
➢Cutler-Beard (Bridge) Flap

• FULL-THICKNESS LOSS

UPPER LID

DEFECTS UP TO LESS THAN 25% OF THE LID MAY BE
CLOSEDPRIMARILY IN OLDER PATIENTS WITH SIGNIFICANT
LAXITY.

WHENSIGNIFICANT TENSION IS PRESENT, LATERAL
CANTHOTOMY AND CANTHOLYSIS
MAY PROVIDE ADDITIONAL LAXITY FOR CLOSURE.

• Advantages
• Lash continuity

• Disadvantages
• Ptosis possible with

tight closure

DIRECT
CLOSURE

FLAP RECONSTRUCTION
DEFECTS BETWEEN {30% TO 75%}
• TENZEL SEMICIRCULARFLAPCOMBINING LATERAL

CANTHOTOMY AND CANTHOLYSIS WITH A LATERALLY
BASED MYOCUTANEOUS FLAPALLOWS CLOSURE OF
DEFECTS OF UPTO 60% OF THE UPPER LID.

Advantages
• Reconstructing of large anterior lamella defects

Disadvantages
• No lash restoration
• Requires posterior lamella coverage

TENZEL
FLAP

SLIDING
TARSOCONJUNCTIVAL

FLAP

• LID-SHARING FLAP(MUSTARDE PEDICLEDFLAP) USED
FOR DEFECTS OF THE CENTRAL UPPER LID.

• FLAP DIVIDED ABOUT 6 WEEKS AND DONOR SITE
CLOSED

• TEMPORAL FOREHEADFLAP(FRICKEFLAP) WHEN
ADEQUATE LID TISSUE IS UNAVAILABLE FOR DONOR
TISSUE,TEMPORALLY BASED FLAPS MAY BE USEFULL.
TISSUE QUALITY IS THICKER AND LESSIDEAL; IT SHOULD
BERESERVED FORSPECIALCIRCUMSTANCES.

POSTERIOR LAMELLAR GRAFT

➢Good for patients with skinlaxity

Posterior lamelladefect
– Conjunctival advancement.
– Supplement with ear cartilage

REVERSE
HUGHES

-Note: Another type of
flap good for up to 70%of
margin is the upper lid
advancement
tarsoconjunctival flap with
a skin graft.

POSTERIOR LAMELLAR
GRAFT WITH LOCAL
MYOCUTANEOUS FLAP

CUTLER-BEARD (BRIDGE)
FLAP

➢ Usedfor 60%to entire liddefects
➢ Borrows skin,muscleandconjunctivafrom lower eyelid
➢ Autogenouscartilageto providesupport
➢ Requires 2nd stageprocedure

• CUTLER-BEARD FLAPPROCEDURE ENTAILS ADVANCEMENT
OF A FULL-THICKNESS LOWERLID FLAPPASSED BENEATH
THE LOWERLID MARGIN AND SUTURED INTO THE DEFECT.
LACKS SUPPORT AT THE LID MARGIN AND REQUIRES
CARTILAGE GRAFTING BETWEENTHE CONJUNCTIVAAND
MUSCLE LAYERS.FLAPDIVISION PERFORMEDAT 3 - 6
WEEKS.

CUTLER-BEARD
(BRIDGE) FLAP

Thank
you


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