Direct eyelid defect closure: a prospective study of functional and aesthetic outcomes

Abstract

Background/Objectives Direct closure (DC) of eyelid defects has been retrospectively shown to give excellent outcomes. We present prospective outcome data as further evidence to promote its wider use. Subjects and Methods A consecutive, unselected, series of patients undergoing eyelid tumour resection was studied prospectively. DC was attempted at the time of biopsy in all of them. If DC proved impossible, delayed reconstruction using other techniques was later performed. Defect size, pre-and post-operative palpebral aperture (PA) measurements and the final visit patients' and surgeons' satisfaction scores for function and appearance were recorded. Results Seventy-three eyelids of 70 patients were studied. Mean resected specimen width was 16.4 mm (4-26 mm) in the DC group, versus 23.9 mm (11-42 mm) for other, non-DC reconstructions. Primary DC was achieved in 74% of this cohort. Mean final post-operative PA measurements in the DC group were 0.7 mm vertically (p = 0.003) and 0.8 mm horizontally (p = 0.009) less than preoperatively, but there was no statistical difference (p = 0.1) in the final horizontal measurements between the operated and un-operated sides in the DC group. DC satisfaction scores were excellent for both eyelid function and appearance. Conclusions DC of eyelid defects, irrespective of per-operative PA distortion, gives excellent late post-operative outcomes. We recommend that DC, aligning the closure tension parallel to the lid margin, is attempted whenever wound margin approximation is possible in preference to alternative reconstruction techniques, regardless of any temporary PA distortion and globe displacement that this may cause. Eyelid function and appearance recover to near normal within 2 months.

A One-Step Model for Eyelid Tumors Surgery During the Pandemic and Beyond

“…However, DC of larger defects may be achieved if the vectors for closure are directed between the medial and lateral canthi or perpendicular to the Langer lines in the periocular region. 5 A recent study reporting the outcomes of DC under tension of periocular defects ranging between 29% and 108% of the horizontal palpebral aperture-with mean horizontal and vertical defect sizes measuring 16.4 mm (range, 4-26 mm) and 12.6 mm (range, 4-32 mm)-showed comparable palpebral apertures (vertical and horizontal planes) between the operated and nonoperated eyes, with high patient satisfaction rates and good cosmesis. 5 Direct closure of defects greater than one-third of the eyelid often requires extreme tension, which may result in temporary palpebral aperture and eyelid margin distortion, upper eyelid ptosis, and upward globe displacement.…”

“…However, DC of larger defects may be achieved if the vectors for closure are directed between the medial and lateral canthi or perpendicular to the Langer lines in the periocular region. 5…”

“…A recent study reporting the outcomes of DC under tension of periocular defects ranging between 29% and 108% of the horizontal palpebral aperture—with mean horizontal and vertical defect sizes measuring 16.4 mm (range, 4–26 mm) and 12.6 mm (range, 4–32 mm)—showed comparable palpebral apertures (vertical and horizontal planes) between the operated and nonoperated eyes, with high patient satisfaction rates and good cosmesis. 5…”

“…However, these changes subside rapidly with eyelid function and appearance returning to near normal by 2 months. 5,6…”

“…Previous studies have shown comparable recurrence rates between Mohs micrographic surgery and excisional biopsy of periocular BCCs. [2][3][4][5] Peden et al 3 studied 185 patients who had small margin (≤2 mm) excision of clinically well-demarcated primary periocular BCCs in the non-Mohs setting of a one-stop clinic and demonstrated a recurrence rate of 3 of 185 (1.62%) at a minimum of 11 years' follow-up. Similar outcomes were found in a large study by Hamada et al 4 with a zero recurrence rate for noninfiltrative BCCs excised with 2-4 mm margins and with 70% of the defects managed by primary direct closure (DC) irrespective of their size.…”