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