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      Reconstruction of medial canthal region with orbicularis oculi myocutaneous flap: Our experience

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          Summary

          Reconstructive surgery of the medial canthus is among one of the most challenging due to its complex anatomy and aesthetic features. In this area even the slightest deformity or asymmetry is noticeable. Reconstructive surgery of this anatomical region aims to restore the tissue defect ensuring an appropriate aesthetic and functional feature, restoring colour, thickness and consistency of the replaced tissue. Orbicularis oculi myocutaneous flap is an option to reconstruct the medial canthal region; in this paper the authors present their experience with orbicularis oculi myocutaneous flap in 10 patients with medial canthal malignant lesions. The patients’ postoperative period was uneventful, the flaps usually showed some degree of temporary venous congestion during the first days after surgery, and any donor site morbidity was observed: no lid lag, ectropion, ptosis, or other eyelid deformity.

          This flap offers a similarity in texture, colour, and thickness to the recipient site and a negligible incidence of donor site morbidity, and it can be easily tailored to fit the shape of the soft tissue defect.

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          Periocular reconstruction: a systematic approach.

          H M Spinelli, G W Jelks (1993)
          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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            Medial canthal reconstruction using a medially based upper eyelid myocutaneous flap.

            Glenn Jelks, Paul M Glat, Elizabeth Jelks … (2002)
            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.
            Article 0 comments Cited 10 times – based on 0 reviews     Review now
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              A combined flap reconstruction for full-thickness defects of the medial canthal region.

              Teruichi Harada, H Motomura, T Taniguchi … (2005)
              The medial canthus is an aesthetically and functionally important area. Adequate consideration of the local anatomy is essential when reconstructing this area. We developed a combined flap technique with a simple combination of standard flaps for the treatment of extensive defects of the nose and upper and lower eyelids, including full-thickness medial canthus defect. In our technique, a median forehead island flap is used for the nasal region, the anterior surface of the eyelid is reconstructed along aesthetic unit, and the posterior surface is reconstructed with a palatal mucoperiosteal graft. A cheek flap is then used for the reconstruction of the lower eyelid. When reconstructing a small defect of the upper eyelid, the upper eyelid is advanced, while a V-Y advancement flap within the upper eyelid is used for a large defect. To reconstruct the acute angle of the medial canthus, a 0.3 mm titanium wire was passed through the tip of the tarsal plate of the upper and lower eyelids to be reconstructed and was fixed in the perforated nasal bone on the affected side. Using this technique, the acute angle of the medial canthus is well preserved after surgery, and is located symmetrically with its counterpart on the intact side. Our technique provides good reconstructive results and should serve as a valid alternative for the reconstruction of this area.
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                Author and article information

                Contributors
                Diletta Maria Pierazzi
                Journal
                Journal ID (nlm-ta): JPRAS Open
                Journal ID (iso-abbrev): JPRAS Open
                Title: JPRAS Open
                Publisher: Elsevier
                ISSN (Electronic): 2352-5878
                Publication date PMC-release: 24 July 2023
                Publication date Collection: September 2023
                Publication date (Electronic): 24 July 2023
                Volume: 37
                Pages: 171-174
                Affiliations
                [a ]Division of Plastic and Reconstructive Surgery, Department of Medicine, Surgery and Neuroscience, “Santa Maria alle Scotte” Hospital, University of Siena, Siena 53100, Italy
                [b ]Department of Surgery, Operative Unit of Reconstructive Surgery and Microsurgery, ASST Valle Camonica. 25040 Esine, Brescia Italy
                Author notes
                [* ]Corresponding author at: Division of Plastic and Reconstructive Surgery; Department of Medicine, Surgery and Neuroscience; “Santa Maria alle Scotte” Hospital, Viale Bracci, University of Siena, Siena, Italy. dilettapierazzi@ 123456gmail.com
                Article
                Publisher Item ID: S2352-5878(23)00038-4
                DOI: 10.1016/j.jpra.2023.07.006
                PMC ID: 10427980
                PubMed ID: 37593585
                SO-VID: d495495b-9388-4b15-9776-adcd7fe08b88
                Copyright © © 2023 The Author(s)
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 5 December 2022
                Date accepted : 10 July 2023
                Categories
                Subject: Short Communication

                Keywords: reconstruction of medial canthal region,orbicularis oculi myocutaneous flap,local flaps
                Data availability:
                Keywords: reconstruction of medial canthal region, orbicularis oculi myocutaneous flap, local flaps

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