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1、BACKGOUND,The eyelid reconstruction has always been a challenge for plastic surgeons. From the numerous methods that have ever been reported for achieving both functional and aesthetic results, the method should be selected according to the size of the defect, the location of the defect (either on u
2、pper or lower eyelid, either on medial portion or lateral portion), and the necessity to reconstruct a conjunctiva.,In this article, we present a new design of orbicularis oculi musculocutaneous flap which can ideally be applied for the reconstruction of full-thickness eyelid defect on both upper an
3、d lower eyelid, simultaneously reducing the donor site morbidity. We have operated on 7 patients and obtained stable and satisfactory results. The operation method is presented with a few technical considerations.,PATIENTS AND METHODS,7 patients (consisting of 3 males, 4 females) were applied this m
4、ethod over the past 5 years,Method,we design a transverse spindle shaped flap on the lateral area of the orbit, extending to the temporal area. On the medial edge of the skin paddle, we make sure that the flap has a direct overlapping above the orbicularis oculi muscle. According to our experience,
5、the limit of the flap size is 2 cm vertically; within the limit, donor site can be closed primarily without showing obvious deformity in the lateral orbital area;,FIGURE 3. The flap has been elevated and is to be transposed toward the lower eyelid defect. Enough range of flap rotation is guaranteed.
6、,Case 1,A 51-year-old woman with a slowly growing lesion on the right lower eyelid was presented with a suspicion of basal cell carcinoma. After confirming a diagnosis by the incisional biopsy, we performed an operation under general anesthesia. The tumor was excised with a horizontal safety margin
7、of 5 mm, including posterior lobe of the lid. The skin defect was reconstructed using orbicularis oculi musculocutaneous flap, with a lining made with a free nasal septum chondromucosal graft. Four months later, revision procedure was done as we carried out defatting of the flap. The tumor was obser
8、ved and no local recurrence was found; the patient is satisfied both for the reconstructed eyelid contour and the almost invisible donor site scar (Figs. 4, 5),FIGURE 5. Case 1. Postoperative state. It shows excellent color match with almost invisible donor site scar,FIGURE 4. Case 1. Preoperative s
9、tate.,Case 2,A 66-year-old man has been treated preservatively under a clinical diagnosis of chalazion of left upper eyelid. Taking unexpectedly long time to heal, the presence of malignant tumor was suspected and the patient was referred to us. After an incisional biopsy that made a diagnosis of Me
10、rkel cell carcinoma, we performed an operation with wide excision reconstruction plan, using orbicularis oculi musculocutaneous flap. We obtained a complete flap survival; and 8 months after the operation, the patient is satisfied with the eyelid contour. (Figs. 611).,FIGURE 6-7. Case 2. Preoperativ
11、e state.,FIGURE 8. Case 2. After tumor resection. The conjunctiva has been reconstructed with nasal septum mucocartilage graft.,Postoperative state. Excellent texture match.,Postoperative state. Almost invisible donor site scar,DISCUSSION,Application: intermediate size Blood supply Little donor site
12、 deformity The flap can be applied on either the upper or the lower eyelid without requiring additional tact or theory,CONCLUSION,We have applied our new design of the orbicularis oculi musculocutaneous flap for the reconstruction of the full-thickness eyelid defect in 7 patients. Though the flap si
13、ze is a limitation, the aggression made by the procedure is largely reduced compared with the alternative methods, and at the same time provided us with the cosmetic and functional result. We introduce this technique as an ideal method for the reconstruction of full-thickness eyelid defects of the intermediate size.,Thank you!,