Advancements in the repair of large upper eyelid defects: A 10-year review. Orbit 2021 Dec;40(6):470-480
Date
09/30/2020Pubmed ID
32990145Pubmed Central ID
PMC8005505DOI
10.1080/01676830.2020.1820045Scopus ID
2-s2.0-85091689148 (requires institutional sign-in at Scopus site) 16 CitationsAbstract
PURPOSE: The reconstruction of large (>50%) upper eyelid margin defects can be technically challenging, with multiple approaches described in the literature. We sought to review the recent literature for new techniques or modifications to existing techniques.
METHODS: We conducted a Pubmed search for technique papers on the reconstruction of large upper eyelid defects published within the past ten years with a minimum of four patients.
RESULTS: We identified ten articles, and divided them into techniques that use a bridging flap from the lower eyelid and those that do not. The number of upper eyelids repaired in each article ranged from 4 to 17. Most techniques could be considered either a modification of the Cutler-Beard technique or a novel anterior lamella flap laid over a graft for the posterior lamella. Postoperative complications included upper or lower eyelid cicatricial retraction, trichiasis, entropion, and lagophthalmos.
CONCLUSIONS: Surgeons continue to innovate for this challenging reconstructive surgery. Overall, the trend was to use a graft, most commonly tarsoconjunctiva from the contralateral upper lid, to replace the posterior lamella, and a skin flap, from the lower eyelid or from the adjacent periorbital area, to replace the anterior lamella. Bridging techniques utilized the skin; the skin, orbicularis, and conjunctiva; or a tarsoconjunctival flap from the lower eyelid. Non-bridging techniques generally used a tarsoconjunctival or substitute graft for the posterior lamella, and a skin flap for the anterior lamella.
Author List
Jennings E, Krakauer M, Nunery WR, Aakalu VKAuthor
Vinay Kumar Aakalu MPH, MD Chair, Professor in the Ophthalmology department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
EntropionEyelid Diseases
Eyelid Neoplasms
Eyelids
Humans
Skin Transplantation
Surgical Flaps
