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Young Seol, philip rizzuto; Factors affecting ectropion rates following facial reconstruction. Invest. Ophthalmol. Vis. Sci. 2017;58(8):3840.
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© ARVO (1962-2015); The Authors (2016-present)
While ectropion is a common complication of many facial reconstructions, it is unclear whether specific surgical techniques can decrease its incidence. We tested the hypothesis that more complicated repairs using flaps, grafts, or implants had higher rates of ectropion postoperatively compared to simpler adjacent tissue transfers.
A retrospective chart review was conducted of all patients in the practice of one surgeon (PRR) who had reconstruction of the cheeks or eyelids during a three-year period (2013-2016). Each patient's age, sex, comorbidities, surgical history, record of follow-up, and postoperative complications, including ectropion requiring surgical repair, were recorded. Procedures were classified as using an adjacent tissue transfer (ATT), myocutaneous pedicle flap (MPF), acellular dermal matrix (ADM) implant, and/or full thickness graft (FTG). Patients without postoperative follow-up were excluded. Statistical significance was determined by logistic regression and Pearson’s chi-square.
A total of 519 operations were performed on 470 patients, of which 266 had a history of Mohs surgery. Mohs patients had significantly lower rates of ATT and significantly higher rates of MPF, ADM, and FTG (Table 1). In both Mohs and non-Mohs subgroups, 55% of patients were women and 45% were men. More women overall received reconstruction than men (p=0.04). The gender distribution did not change by Mohs history (p=0.93). The Mohs subgroup mean age was 65.54, compared to 58.44 for non-Mohs patients (p<.0001). Mean follow-up was 101 days.All patients with ectropion had received ipsilateral reconstruction. Sex (p = 0.16), age (p = 0.19), and laterality (p=0.18) did not have significant effects on ectropion incidence. 4 (1.5%) Mohs patients developed ectropion compared to 1 (0.5%) non-Mohs patient (p=0.29). Patients who received MPF, ADM, or FTG had higher rates of ectropion; patients who received ATT had lower rates (Table 2). This difference was statistically significant for all procedures among all patients and for ATT and ADM among Mohs patients. There was no significant difference in ectropion rates among MPF, ADM, and FTG patients.
Ectropion was more common postoperatively among patients with more complicated reconstructions. Mohs patients required more complicated repairs and may be more likely to develop ectropion.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
Table 1. Procedures by group
Table 2. Rates of ectropion (%) following reconstruction
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