Lazy Pentagonal Wedge Resection of Eyelid Margin Lesions

Garcia, Giancarlo A.; Nguyen, Christine V.; Vo, Thomas A.; Yonkers, Marc; Minckler, Don S.; Tao, Jeremiah

doi:10.1001/jamafacial.2017.1902

Cited by 7 publications

(6 citation statements)

References 6 publications

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“…[10][11][12] A vertical scar was inevitable, so some techniques, such as curvilinear pentagonal wedge resection or resection below the musculocutaneous flap, were proposed to diminish its length. 13,14 Sometimes combining direct closure with canthotomy and cantholysis was necessary to avoid wound dehiscence or palpebral fissure deformation caused by high horizontal tension. For these cases, surgical complexity and injury to normal tissue increased, and direct closure was not preferred.…”

Section: Discussionmentioning

confidence: 99%

“…For VSS, 0-3 was none; 4-6 was slight; 7-9 was moderate; and 10-13 was severe. 6 Each patient's total score was classed as excellent (0-10), good (11)(12)(13)(14)(15)(16)(17)(18)(19)(20), or poor (21)(22)(23)(24)(25)(26)(27)(28)(29)(30). A patient satisfaction survey was conducted, with possible ratings of not satisfied, slightly satisfied, moderately satisfied, or very satisfied.…”

Section: Methodsmentioning

confidence: 99%

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Two Advancement Flaps for Eyelid Margin Reconstruction of Small and Medium Defects and a Novel Design to Reduce Ocular Injury

Dai

Zhang

et al. 2023

CCID

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The key point of eyelid margin reconstruction is to keep both the support function and aesthetic appearance. The eyelid's complex anatomical structures make eyelid margin reconstruction demanding. Eyelid margin defects are conventionally classified by their width relative to the eyelid width: small, medium, or large. In this study, we introduce a reconstruction method for small to medium defects. Patients and Methods: We conducted a single-center case series of patients from the practice of a single experienced plastic surgeon at a tertiary center. We included consecutive outpatients from 2014 to 2021. The inclusion criteria were (1) eyelid margin mass and (2) willingness to receive eyelid margin reconstruction by the reported method. The exclusion criteria were (1) eyelid margin mass involving most or all of the tarsus and (2) less than one year of follow-up. Patients were followed up face to face or online. Patients' demographics, clinical characteristics and outcomes, and satisfaction were collected. The clinical outcomes were assessed and scored by two plastic surgeons. Procedure: We reconstructed the anterior lamella with an advancement musculocutaneous flap and repaired the posterior lamella with a specially designed advancement tarsoconjunctival flap, of which a piece of tarsus was shaved and the corresponding remnant conjunctiva was bent forward to cover the tarsus edge to avoid ocular injury. Results: We included 24 patients (25 lesions). Almost all patients had eyelash discontinuity. One patient presented slight notching of the lower eyelid margin. The other patients reported no complications or recurrence. The average outcome score was 1.23±0.69, indicating that our method was excellent. All patients were very satisfied with the surgery. The average follow-up time was 5.75 years. Conclusion:We report a reconstruction method for small to medium eyelid margin defects and a novel design for preventing ocular injury, which is an especially good option for transverse defects.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Two Advancement Flaps for Eyelid Margin Reconstruction of Small and Medium Defects and a Novel Design to Reduce Ocular Injury

Dai

Zhang

et al. 2023

CCID

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“…The inverted pentagonal defect makes apposition of the tarsal plate and eyelid margin straightforward, thus ensuring optimal lid function and integrity and avoiding asymmetry and notching. 5 Although primary closure is ideal for anticipated defects involving 25% to 40% of the eyelid margin, a pentagonal defect is suitable for even much larger defects, which may be resurfaced with lateral canthotomy with inferior cantholysis, Tenzel semicircular rotation flapa, tarsoconjunctival grafts and flaps, periosteal flaps, and combination approaches. An initial wedge resection should not interfere with or otherwise alter outcomes when used appropriately.…”

Section: Discussionmentioning

confidence: 99%

Preparing for and Executing a Pentagonal Wedge Mohs Layer for Tumors of the Marginal Eyelid

et al. 2021

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A pproximately 20% of basal cell carcinomas involving the head and neck arise on the eyelid(s). 1 Reliable tumor extirpation and successful reconstruction at this site is critical. 2 Tumors at this site invariably result in full-thickness defects requiring methodical reconstruction of the anterior and posterior lamellae, therefore limiting repair options. 3,4 Herein, we describe our preferred pentagonal wedge Mohs technique, which allows for efficient and reliable tumor removal and tissue processing and minimizes necessary defect preparation before closure.

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“…Direct closure maximizes native tarsus and ensures continuity of eyelashes. 24,25 Excessive tension may result in eyelid malposition or ectropion. In these cases, one of the options below should be considered.…”

Section: Defects 25% To 33%mentioning

confidence: 99%

Complex Eyelid Reconstruction: A Practical Guide for the Mohs Surgeon

et al. 2022

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BACKGROUND A growing body of literature suggests that Mohs micrographic surgeons can safely and successfully perform complex eyelid reconstruction. Given that up to 10 percent of all skin cancers occur on the periorbital skin, it is imperative that Mohs surgeons understand form and function to properly assess the defect and select the appropriate reconstruction method for a variety of eyelid defects. OBJECTIVE Our objective is to provide a thorough understanding of eyelid anatomy with an emphasis on form and function, provide a framework for defect analysis, and an algorithmic approach to defect analysis and appropriate selection of repair. METHODS AND MATERIALS A review of the literature on eyelid reconstruction was performed with specific reference to defect analysis and appropriately choosing repairs that are applicable to Mohs micrographic surgeons. CONCLUSION Mohs micrographic surgeons can safely and successfully perform complex eyelid repairs. An understanding of eyelid anatomy is the first step toward the best surgical outcome, and there are various methods for reconstructing eyelid defects. Defect size, location and analysis of the anterior lamella, posterior lamella, and the canthal regions helps to create an organized operative plan.

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Lazy Pentagonal Wedge Resection of Eyelid Margin Lesions

Cited by 7 publications

References 6 publications

Two Advancement Flaps for Eyelid Margin Reconstruction of Small and Medium Defects and a Novel Design to Reduce Ocular Injury

Two Advancement Flaps for Eyelid Margin Reconstruction of Small and Medium Defects and a Novel Design to Reduce Ocular Injury

Preparing for and Executing a Pentagonal Wedge Mohs Layer for Tumors of the Marginal Eyelid

Complex Eyelid Reconstruction: A Practical Guide for the Mohs Surgeon

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