RECONSTRUCTIVE METHODS FOR LOWER EYELID DEFECTS IN DERMATOLOGICAL PRACTICE
Autor(a) principal: | |
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Data de Publicação: | 2014 |
Outros Autores: | , , , |
Tipo de documento: | Artigo |
Idioma: | por |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | https://doi.org/10.29021/spdv.71.2.165 |
Resumo: | Introduction: Most cases of lower eyelid reconstruction are due to defects resulting from resection of skin malignancies. The principles of eyelid reconstruction have been established, but it remains challenging to achieve good functional and aesthetic reconstruction. Material and Methods: Knowing the principles of eyelid reconstruction as well as of the basic anatomy is crucial when approaching the repair of eyelid defects. The eyelid may be divided into two lamellae: the anterior lamella includes the skin and the orbicularis muscle while the posterior lamella includes the tarsus and the conjunctiva. Results: For reconstructive purposes the eyelid reconstruction may be divided into two main groups: (1) partial thickness defects with intact margin and (2) full-thickness defects involving the eyelid margin. Surgical closure techniques to reconstruct the anterior lamella include advancement or rotation myocutaneous flaps or full-thickness skin grafts. A graft is necessary to reconstruct the posterior lamella. Both of these lamellae must be replaced in the repair of full-thickness defects in order to restore their function. The algorithms to repair the full-thickness marginal defects are classified into: small (up to 30% of the horizontal dimension of the lid margin), medium (30%-50%), and large (upper than 50%). A small defect can usually be repaired by primary closure. In case of need, the lateral eyelid margin can be mobilized 3 to 5 mm by performing an inferior or superior cantholysis. To repair a moderately sized defect, a skin flap can be performed. For large defects, the surgeon must reconstruct the posterior lamella and rely on a combination of the previously used lower eyelid repair techniques. The authors review the methodology of reconstruction of lower eyelid defects illustrating with clinical cases from their experience.Conclusion: There are several procedures available to restore the natural eyelid contour. The appropriate reconstructive path depends on the particular clinical scenario. The dermatologic surgeon should be familiar with various reconstructive options for lower eyelid defects selecting the best option for each patient. |
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RECONSTRUCTIVE METHODS FOR LOWER EYELID DEFECTS IN DERMATOLOGICAL PRACTICEMÉTODOS RECONSTRUTIVOS DA PÁLPEBRA INFERIOR – APLICAÇÃO NA PRÁTICA DERMATOLÓGICAEyelidsReconstructive surgical proceduresSurgical flapsSkin transplantationPálpebra inferiorReconstruçãoRetalho cutâneoEnxerto cutâneoIntroduction: Most cases of lower eyelid reconstruction are due to defects resulting from resection of skin malignancies. The principles of eyelid reconstruction have been established, but it remains challenging to achieve good functional and aesthetic reconstruction. Material and Methods: Knowing the principles of eyelid reconstruction as well as of the basic anatomy is crucial when approaching the repair of eyelid defects. The eyelid may be divided into two lamellae: the anterior lamella includes the skin and the orbicularis muscle while the posterior lamella includes the tarsus and the conjunctiva. Results: For reconstructive purposes the eyelid reconstruction may be divided into two main groups: (1) partial thickness defects with intact margin and (2) full-thickness defects involving the eyelid margin. Surgical closure techniques to reconstruct the anterior lamella include advancement or rotation myocutaneous flaps or full-thickness skin grafts. A graft is necessary to reconstruct the posterior lamella. Both of these lamellae must be replaced in the repair of full-thickness defects in order to restore their function. The algorithms to repair the full-thickness marginal defects are classified into: small (up to 30% of the horizontal dimension of the lid margin), medium (30%-50%), and large (upper than 50%). A small defect can usually be repaired by primary closure. In case of need, the lateral eyelid margin can be mobilized 3 to 5 mm by performing an inferior or superior cantholysis. To repair a moderately sized defect, a skin flap can be performed. For large defects, the surgeon must reconstruct the posterior lamella and rely on a combination of the previously used lower eyelid repair techniques. The authors review the methodology of reconstruction of lower eyelid defects illustrating with clinical cases from their experience.Conclusion: There are several procedures available to restore the natural eyelid contour. The appropriate reconstructive path depends on the particular clinical scenario. The dermatologic surgeon should be familiar with various reconstructive options for lower eyelid defects selecting the best option for each patient. Introdução: A ressecção de neoplasias cutâneas é a principal causa de defeitos palpebrais. Os princípios de reconstrução da pálpebra encontram-se bem definidos. No entanto, permanece um desafio conseguir um bom resultado funcional e estético. Material e Métodos: Conhecer as diversas técnicas cirúrgicas e os conceitos anatómicos é fundamental na abordagem de lesões palpebrais. Anatomicamente a pálpebra pode ser dividida em duas lamelas: a lamela anterior (pele e músculo orbicular) e a lamela posterior (tarso e conjuntiva).Resultados: Para efeitos reconstrutivos, os defeitos da pálpebra inferior podem ser divididos em dois principais grupos: (1) defeitos de espessura parcial, com a margem palpebral intacta e (2) defeitos de espessura total envolvendo a margem palpebral. As técnicas cirúrgicas de reconstrução da lamela anterior incluem retalhos miocutâneos de rotação ou de deslizamento e enxertos cutâneos. Para reconstruir a lamela posterior são necessários enxertos compostos (condrocutâneos ou condromucosos). Nos defeitos de espessura total ambas as lamelas têm de ser reparadas, para restaurar a função. Nos algoritmos de reconstrução, os defeitos palpebrais de espessura total são classificados em: pequenos (até 30% do tamanho horizontal da margem palpebral), médios (30-50%) e grandes (acima de 50%). Um pequeno defeito pode ser encerrado com sutura directa. Se necessário mobiliza-se a margem palpebral lateral 3 a 5 mm (cantólise lateral). Num defeito de tamanho médio pode ser aplicado um retalho. Para os defeitos de grandes dimensões, o cirurgião deve reconstruir a lamela posterior e planear a reconstrução da lamela anterior com uma combinação das técnicas anteriores. Os autores reviram a metodologia de reconstrução de defeitos da pálpebra inferior e exemplificam com casos da sua prática clínica. Conclusões: Existem inúmeras abordagens possíveis para restaurar a anatomia palpebral. O método reconstrutivo de eleição é individualizado caso a caso, com particular atenção à localização e dimensões do defeito. Sociedade Portuguesa de Dermatologia e Venereologia2014-06-24T00:00:00Zinfo:eu-repo/semantics/articleinfo:eu-repo/semantics/otherinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://doi.org/10.29021/spdv.71.2.165oai:ojs.revista.spdv.com.pt:article/165Journal of the Portuguese Society of Dermatology and Venereology; Vol 71 No 2 (2013): Abril-Junho; 159-169Revista da Sociedade Portuguesa de Dermatologia e Venereologia; v. 71 n. 2 (2013): Abril-Junho; 159-1692182-24092182-2395reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPporhttps://revista.spdv.com.pt/index.php/spdv/article/view/165https://doi.org/10.29021/spdv.71.2.165https://revista.spdv.com.pt/index.php/spdv/article/view/165/148Teixeira, VeraRamos, LeonorSerra, DavidVieira, RicardoFigueiredo, Américoinfo:eu-repo/semantics/openAccess2022-10-06T12:34:42Zoai:ojs.revista.spdv.com.pt:article/165Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T16:10:43.205545Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
RECONSTRUCTIVE METHODS FOR LOWER EYELID DEFECTS IN DERMATOLOGICAL PRACTICE MÉTODOS RECONSTRUTIVOS DA PÁLPEBRA INFERIOR – APLICAÇÃO NA PRÁTICA DERMATOLÓGICA |
title |
RECONSTRUCTIVE METHODS FOR LOWER EYELID DEFECTS IN DERMATOLOGICAL PRACTICE |
spellingShingle |
RECONSTRUCTIVE METHODS FOR LOWER EYELID DEFECTS IN DERMATOLOGICAL PRACTICE Teixeira, Vera Eyelids Reconstructive surgical procedures Surgical flaps Skin transplantation Pálpebra inferior Reconstrução Retalho cutâneo Enxerto cutâneo |
title_short |
RECONSTRUCTIVE METHODS FOR LOWER EYELID DEFECTS IN DERMATOLOGICAL PRACTICE |
title_full |
RECONSTRUCTIVE METHODS FOR LOWER EYELID DEFECTS IN DERMATOLOGICAL PRACTICE |
title_fullStr |
RECONSTRUCTIVE METHODS FOR LOWER EYELID DEFECTS IN DERMATOLOGICAL PRACTICE |
title_full_unstemmed |
RECONSTRUCTIVE METHODS FOR LOWER EYELID DEFECTS IN DERMATOLOGICAL PRACTICE |
title_sort |
RECONSTRUCTIVE METHODS FOR LOWER EYELID DEFECTS IN DERMATOLOGICAL PRACTICE |
author |
Teixeira, Vera |
author_facet |
Teixeira, Vera Ramos, Leonor Serra, David Vieira, Ricardo Figueiredo, Américo |
author_role |
author |
author2 |
Ramos, Leonor Serra, David Vieira, Ricardo Figueiredo, Américo |
author2_role |
author author author author |
dc.contributor.author.fl_str_mv |
Teixeira, Vera Ramos, Leonor Serra, David Vieira, Ricardo Figueiredo, Américo |
dc.subject.por.fl_str_mv |
Eyelids Reconstructive surgical procedures Surgical flaps Skin transplantation Pálpebra inferior Reconstrução Retalho cutâneo Enxerto cutâneo |
topic |
Eyelids Reconstructive surgical procedures Surgical flaps Skin transplantation Pálpebra inferior Reconstrução Retalho cutâneo Enxerto cutâneo |
description |
Introduction: Most cases of lower eyelid reconstruction are due to defects resulting from resection of skin malignancies. The principles of eyelid reconstruction have been established, but it remains challenging to achieve good functional and aesthetic reconstruction. Material and Methods: Knowing the principles of eyelid reconstruction as well as of the basic anatomy is crucial when approaching the repair of eyelid defects. The eyelid may be divided into two lamellae: the anterior lamella includes the skin and the orbicularis muscle while the posterior lamella includes the tarsus and the conjunctiva. Results: For reconstructive purposes the eyelid reconstruction may be divided into two main groups: (1) partial thickness defects with intact margin and (2) full-thickness defects involving the eyelid margin. Surgical closure techniques to reconstruct the anterior lamella include advancement or rotation myocutaneous flaps or full-thickness skin grafts. A graft is necessary to reconstruct the posterior lamella. Both of these lamellae must be replaced in the repair of full-thickness defects in order to restore their function. The algorithms to repair the full-thickness marginal defects are classified into: small (up to 30% of the horizontal dimension of the lid margin), medium (30%-50%), and large (upper than 50%). A small defect can usually be repaired by primary closure. In case of need, the lateral eyelid margin can be mobilized 3 to 5 mm by performing an inferior or superior cantholysis. To repair a moderately sized defect, a skin flap can be performed. For large defects, the surgeon must reconstruct the posterior lamella and rely on a combination of the previously used lower eyelid repair techniques. The authors review the methodology of reconstruction of lower eyelid defects illustrating with clinical cases from their experience.Conclusion: There are several procedures available to restore the natural eyelid contour. The appropriate reconstructive path depends on the particular clinical scenario. The dermatologic surgeon should be familiar with various reconstructive options for lower eyelid defects selecting the best option for each patient. |
publishDate |
2014 |
dc.date.none.fl_str_mv |
2014-06-24T00:00:00Z |
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info:eu-repo/semantics/article info:eu-repo/semantics/other |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://doi.org/10.29021/spdv.71.2.165 oai:ojs.revista.spdv.com.pt:article/165 |
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https://doi.org/10.29021/spdv.71.2.165 |
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oai:ojs.revista.spdv.com.pt:article/165 |
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https://revista.spdv.com.pt/index.php/spdv/article/view/165 https://doi.org/10.29021/spdv.71.2.165 https://revista.spdv.com.pt/index.php/spdv/article/view/165/148 |
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info:eu-repo/semantics/openAccess |
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openAccess |
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application/pdf |
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Sociedade Portuguesa de Dermatologia e Venereologia |
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Sociedade Portuguesa de Dermatologia e Venereologia |
dc.source.none.fl_str_mv |
Journal of the Portuguese Society of Dermatology and Venereology; Vol 71 No 2 (2013): Abril-Junho; 159-169 Revista da Sociedade Portuguesa de Dermatologia e Venereologia; v. 71 n. 2 (2013): Abril-Junho; 159-169 2182-2409 2182-2395 reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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RCAAP |
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RCAAP |
reponame_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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