Medial Canthal Reconstruction by a Modified Glabellar Flap

Abstract

Aims: To present a modified technique for the preparation of glabellar skin flaps to reconstruct medial canthal defects. Methods: Ten consecutively treated patients were included who had skin defects after resection of skin tumours like basal cell carcinomas in the medial canthal area of a medium vertical diameter of 2.5 cm. The defects were closed by preparation of a modified glabellar flap. The pedicle of the flap was guided through a skin tunnel prepared diagonally at the root of the nose. The pedicle was resected 4 weeks after the initial surgery. Results: In all 10 cases, the procedure was adequate for reconstruction of the defect. There were no flap necroses and the cosmetic results were favourable in all cases. The resection of the pedicle could be performed easily in an out-patient procedure 4 weeks after the operation. Conclusion: Glabellar flaps are established procedures to reconstruct medium to large defects of the medial canthus. Skin distortion in the area of the flap pedicle leading to a skin bulge and visible scars at the root of the nose and medial transposition of the eye brows can be reduced by a modification of the surgical technique preparing a skin tunnel for the flap pedicle. In our hands, the cosmetic results are better with the modified technique in comparison to the original procedure.

Preauricular full-thickness skin grafting in medial canthal reconstruction

“…Other grafts are the thin-skin grafts, such as the Ollier-Thiersh graft (0.20-0.35 mm), and the middle-thickness grafts such as the Blair-Brown (0.40-0.60 mm) or Padgett (0.60-0.80 mm) grafts. Both thin-skin and middle-thickness grafts can only be taken with the use of a dermatome [3]. When used in periocular reconstruction they are usually harvested from several possible donor sites (upper lid, preauricular, retroauricular, neck, clavicular and supraclavicular, and inner brachial area) yielding different graft thicknesses accordingly [6].…”

“…Graft hypertrophy was most common in medial canthal defect reconstruction compared with other periocular sites [3,6]. The exact mechanism for graft hypertrophy is not fully understood, and it probably represents aberration in the process of wound healing, which includes cell proliferation, inflammation, and increased synthesis of cytokines and extracellular matrix proteins [6].…”

“…Reconstructive techniques can be classified considering the anatomical area requiring treatment: superior eyelid, inferior eyelid, and inner or external canthus [3]. Simplifying, we can distinguish: direct wound closure, "laisser faire", free skin grafts, and different types of skin flaps [3,4].…”

“…Simplifying, we can distinguish: direct wound closure, "laisser faire", free skin grafts, and different types of skin flaps [3,4]. Direct closure is reserved to very small defects, 'laisser faire' can lead to a remarkable extent of undesired scarring and a cosmetically unfavorable outcome.…”

“…Finally the risk of hypertrophy of the free skin transplant is highest when transferred into the medial canthus. For these reasons, is that free skin grafts might be even used too often [3]. By definition, a skin flap differs from a skin graft because it consists not only of skin but also of subcutaneous tissue with its subdermal plexus of vessels.…”