IntroductionEye lid reconstruction followed by severe, extensive body and facial burns represents a surgical challenge due to difficulties to obtain proper, healthy skin graft, tissue ischemia and necrosis.Presentation of caseWe present a reconstructive lid surgery of cicatricial bilateral lower eyelid ectropion in a case of 31-year-old man who sustained thermal injuries, affecting more than 60% of total body surface area, causing severe, deep dermal burns. Reconstruction was made using the technique of skin cantus-to-cantus incision, contracture release, orbicularis liberation and lid elevation; and oversizing free full-thickness skin graft (FTSG) (Wolfe technique) from the left inguinal region, as the only healthy skin on the entire body surface. Residual lower left lid laxity was addressed by pentagonal wedge resection, not interrupting marginal arcade vessels, thus minimizing ischemia.DiscussionMethod of choice of the graft type has been much debated question; however, significantly less reoccurrence rate of ectropion was observed using FTSG. Time of grafting should be balanced to avoid excess granulation and, thus scaring caused by delayed grafting time, or poor graft adherence caused by premature grafting. An interruption of the marginal arcade vessels should not be performed due to already severe ischemic process and increased risk for lid necrosis.ConclusionMajor issues when addressing cicatricial ectropion followed by severe burns are: right donor site selection, appropriate graft thickness with the least possible disturbance of the affected place vascularisation, followed by immediate grafting after debridement of scaring and unhealthy tissue, with generous preservation of the orbicularis muscle.
<p><strong>Aim</strong> <br />To examine and quantify patients&rsquo; satisfaction and correlate with the objective clinical presentation after the treatment and to present a comprehensive literature review on tarsoconjunctival/ Hughes flap technique.<br /><strong>Methods</strong> <br />A review of more than 159 peer-review articles and a combined retrospective-prospective two-centres case series of 17<br />patients who underwent a two-stage modified Hughes flap procedure (2019-2021) to repair a lower eyelid defect caused by epithelial cancer was conducted. All patients were followed up for a minimum of six months. Patient macroscopic evaluation of redness, lid position, retraction, trichiasis, conjunctival overgrowth, tissue inflammation/infection and hypertrophic scarring were obtained, and findings were graded on a scale of 1 to 5 or binary YES/NO scale. Patients&rsquo; satisfaction using a Likert-type scale and correlation with the clinical presentation were analysed.<br /><strong>Results</strong> <br />Pearson correlation coefficient between patients&rsquo; satisfaction and clinical presentation was 0.534. Out of 510 (the highest<br />summed score for patients&rsquo; satisfaction), the total score was 479 (93.9%); out of 187 (the highest summed score for clinical presentation), the total score was 162 (86.6%). Although both scores were high, a lower correlation coefficient and the higher satisfaction score can be explained by more realistic expectations in oncological patients compared to cosmetic ones.<br /><strong>Conclusion</strong> <br />Hughes flaps provide multiple benefits in the reconstruction of selected patients with large defects, especially when<br />poor wound healing is expected, or when local advancement flaps do not provide tension-free reconstruction. The rate of complications is low and manageable, whereas additional therapy is usually observational or symptomatic.&nbsp;</p>
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