Periosteal Flap As A Posterior Lamella In The Reconstruction Of Large Eyelid Defects Following Tumor Resection Or Trauma

Abstract

Purpose: : Large full thickness eyelid defects following trauma or removal of a tumor can be challenging to repair. The use of a periosteal flap for the reconstruction of posterior lamellar eyelid defects was first described by Byron Smith in 1981. In cases of large full-thickness eyelid defects, reconstruction can be accomplished by elevation and rotation of a periosteal flap as a posterior lamella. Herein we evaluate the efficacy of periosteal flaps as a posterior lamella in the reconstruction of large eyelid defects created by removal of large eyelid tumors or following trauma.

Methods: : Retrospective analysis of 28 patients having eyelid defects (>50%) following excision of large tumors or trauma requiring reconstruction by the use of periosteal flaps as a posterior lamella were studied for their efficacy. In cases of both upper and lower eyelid lateral canthal angle loss, periosteal flaps were crossed to form a sharp canthal angle and then sutured to the tarsal edges of the remaining eyelids to create posterior lamella. The anterior lamella of the eyelid was reconstructed by myocutaneous flaps obtained by different techniques. Outcomes assessed included contour of eyelid, eye closure, corneal protection and any complications.

Results: : Among the 28 patients (16 males, 12 females; average age 53.3 years, range 5 to 80 years), in 22 patients eyelid defects resulted after resection of basal cell carcinoma (15), sebaceous cell carcinoma (4), squamous cell carcinoma (3) or trauma (6). Sixteen patients had lateral eyelid defects either with or without lateral canthal area involvement, while 12 patients had medial eyelid defects. Postoperative eyelid contour and eye protection was acceptable in all patients. Other additional surgeries included tarsal conjunctival flaps in 7, entropion repair in 6, full thickness skin grafts in 5 and dacryocystorhinostomy in 2. Exposure keratopathy developed in 3 patients requiring further surgeries. After follow-up at 1 to 62 months, all reconstructed eyelids showed acceptable appearance with good function.

Conclusions: : Periosteal flap as a posterior lamella in the reconstruction of large eyelid defects following tumor resection or trauma should be considered as a good alternate to other methods of posterior lamella reconstruction. The procedure has a relatively low morbidity and good anatomical success in achieving a natural eyelid contour.

Keywords: clinical (human) or epidemiologic studies: outcomes/complications • eyelid • tumors