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      Reconstruction of periorbital region defects: A retrospective study

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          Abstract

          Background:

          Although the periorbital region forms less than 1% of the total body surface, it has a very complex anatomy; therefore, it requires a detailed approach. In this work, we aim to present the clinical applications and related literature for the algorithm of the technique which will be applied, according to the location of the defect, in choosing the surgery treatment method. Factors affecting the results and different treatment methods of the anatomical region, including its difficult reconstruction, will also be included.

          Materials and Methods:

          A review of 177 periorbital region defect reconstructions was performed.

          Results:

          As a treatment method, in 76 (43%) patients primary closure was chosen, 39 (22%) patients had grafts and in 62 (35%) patients a flap was chosen as a treatment alternative. With respect to postoperative complications, there were a total of 6 (3.38%) patients observed with venous congestion. In 11 (6.21%) patients ectropion developed, in 1 (0.56%) patient minimal space between the eyelids while monitoring recovery was observed and in 1 (0.56%) patient, flap loss was observed due to a circulatory disorder.

          Conclusions:

          The aim of reconstruction is to repair the defect suitable to normal physiological and anatomical values. As a result, before the surgical treatments in this difficult anatomical region, the defect width and anatomical localization must be evaluated. The most suitable reconstruction method must be identified, using an evaluation of the algorithm and the required functional and esthetical results can be obtained with intraoperative flexible behavior and a change of method, when necessary.

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          Most cited references24

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          Periocular reconstruction: a systematic approach.

          The records and photographs of 90 patients who underwent reconstructive procedures on the eyelids, canthi, and periocular tissues between 1982 and 1988 were reviewed retrospectively. The defects created by either fresh tissue histologically controlled resection or primary excision were analyzed according to location, size, and degree of resection and visual status. Histologic types included nodular, morphea, and fibrosing basal cell carcinomas; well to poorly differentiated squamous cell carcinoma; and melanoma in situ. The adequacy of both ocular protection and tissue preservation was assessed between 1 and 6 years postoperatively. Anatomic as well as functional reconstructions were performed with a complication rate of 12 percent. There were two tumor recurrences requiring extensive craniofacial extirpation and reconstruction. A systematic method of classifying periocular defects was developed in order to analyze various reconstructive options as well as the type and frequency of complications encountered. This classification system is applicable to primary benign and malignant lesions as well as defects. Analysis of patients who underwent periocular reconstruction in the context of this classification system reveals that larger defects and those involving the medial canthus are more prone to complications. Recurrent complications in the medial and lateral canthal region underscore the necessity of routinely utilizing ancillary procedures such as lacrimal intubation and canthopexy. Recommendations for periocular reconstruction are suggested based on this classification system.
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            Total and subtotal upper eyelid reconstruction with the nasal chondromucosal flap: a 10-year experience.

            The authors review their 10-year experience with the nasal chondromucosal flap for total and subtotal upper eyelid reconstruction. After several modifications, the flap is now designed along the lateral nasal wall and is based on the terminal branch of the dorsal nasal artery, to include the subcutaneous tissues down to the periosteum and the cranial portion of the upper lateral cartilage. A skin graft is applied for cutaneous coverage. The flap can be harvested unilaterally or contralaterally. Fifteen patients, aged 50 to 75 years, have been operated on with this technique for total or subtotal defects of the upper eyelid since 1993. Follow-up included assessment of position, closure, presence of epiphora, length of palpebral rim, eyelid opening, levator function, aesthetic balance, and donor-site morbidity. The flap result was viable in every patient, without total or partial necrosis. Static parameters were within normal ranges, and 8 to 18 mm of levator function (mean, 13 mm) was achieved. Compared with other frequently used techniques, namely, the Cutler-Beard advancement flap and the Mustarde lid switch flap, this procedure is a one-stage operation, does not damage the lower lid, and provides a thin, mobile eyelid with an anatomically complete reconstruction. The nasal chondromucosal flap has thus become the authors' standard for large full-thickness defects of the upper lid.
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              Medial canthal reconstruction using a medially based upper eyelid myocutaneous flap.

              Periorbital reconstruction following skin cancer ablation represents a challenging problem. A thorough understanding of the complex periorbital anatomy is necessary to preserve lid function and protect the ocular surface. The medial canthal region represents the most difficult periorbital zone to reconstruct. This area has a complex anatomy involving both the medial canthus itself and the lacrimal apparatus. The authors present their experience with a versatile technique for reconstruction of the medial canthal periorbital region, namely, a medially based upper eyelid myocutaneous flap. In the 10 patients in whom this procedure was used, there was one partial and no complete flap losses. The authors believe that the medially based upper lid myocutaneous flap offers an excellent solution to the difficult problem of medial canthal periorbital reconstruction.
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                Author and article information

                Journal
                Ann Maxillofac Surg
                Ann Maxillofac Surg
                AMS
                Annals of Maxillofacial Surgery
                Medknow Publications & Media Pvt Ltd (India )
                2231-0746
                2249-3816
                Jan-Jun 2014
                : 4
                : 1
                : 45-50
                Affiliations
                [1]Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, Yuzuncu Yıl University, Van, Turkey
                [1 ]Dışkapı Yıldırım Beyazıt Education and Research Hospital, Ankara, Turkey
                [2 ]Faculty of Medicine, Dicle University, Diyarbakır, Turkey
                Author notes
                Address for correspondence: Dr. Serdar Yüce, Yuzuncu Yil Universitesi, Tip Fakultesi, Plastik Cer. A. D 65100, Van, Turkey. E-mail: yuceserdar23@ 123456yahoo.com
                Article
                AMS-4-45
                10.4103/2231-0746.133077
                4073462
                07f8cc3c-4656-466b-8a30-fafa5c6b3f6d
                Copyright: © Annals of Maxillofacial Surgery

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Original articles - Retrospective Study

                algorithm,periorbital defects,reconstruction
                algorithm, periorbital defects, reconstruction

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