Observations on surgical reconstructive management following the excision of malignant neoplasms of the eyelid and periocular area

Abstract

Background. The surgical treatment of malignant neoplasms of the eyelid and the periocular area, due to the complex structure of the eye protective apparatus, remains a difficult surgical problem. The aim is to reconstruct the missing tissue as precisely as possible, both from a functional and esthetic point of view. Postoperative disorders of eyelid function may considerably disturb both the functioning and the quality of life of the patients. Objectives. The aim of the study was to evaluate 262 patients who had underwent operations related to malignant neoplasms of the eyelid and the periocular area, and to demonstrate which reconstruction methods for post-resection defects were the most advantageous in terms of functions and esthetics. Material and methods. The study was based on an analysis of the medical records of 262 patients. The analysis included the reconstruction techniques used, the patient's age, the sizes and locations of the primary skin cancer, any healing complications, and the distant esthetic and functional outcomes. Results. Various types of flap procedures were the most frequently used techniques in the studied group of patients (66.8%). Single flaps were used in 83 patients, multiple flaps in 89 patients and complex flaps with a cartilage graft in 3 patients. Free skin grafts were used in 52 patients and were associated with complications in the form of partial necrosis. Complications during postoperative wound healing were observed in 18.3% of the patients. In 12 patients, the complications were associated with a local infection, in 15 patients with partial, marginal necrosis and in 8 patients partial wound breakdown after the transfer of the flap occurred. Conclusions. The most frequently used mechanisms for correction and reconstruction of the deficits following the excision of the eyelid skin and periorbital malignancies included various flaps used in a total of 175 patients (66.8%).

Feasibility, comparability and outcomes of three acquainted facial island flaps for periorbital defects reconstruction

“…In the case series reviewed by Richardson et al, the hospital admission in the intensive care unit after free‐flap reconstruction was elongated for at least 24 to 48 h for close observation 12 . In this article, the reconstructive operations performed with three facial island flaps (TFs, FFs and BFs) for the reconstruction of periorbital defects should and could be accomplished after the malignant neoplasms excision procedures, which is consistent with the viewpoints of other studies in the literature 7,13 …”

“…Surrounding tissues are prone to be invaded by malignant tumours, as a result, local or rotation flaps are limited by their less tissue availability and specific functional requirements to cover severe defects because of orbital exenteration. Furthermore, even if free‐flap transfer via vascular anastomosis has been privileged for complex defective wounds, this lengthy surgical procedure brings additional issues to clinicians and patients including the increase of complication risk, hospitalisation and expense 3,7,11 . In the case series reviewed by Richardson et al, the hospital admission in the intensive care unit after free‐flap reconstruction was elongated for at least 24 to 48 h for close observation 12 .…”

“…Although the free-flap reconstruction for secondary wounds poses adopted operating mode currently, this time-consuming surgery with a certain additional trauma at the donor site, long recovery time or underlying risk of embolism brings about negative elements for the reconstruction outcomes, leaving uncertain issues to clinicians. 3,7 The island flaps of the facial artery branches (e.g., superficial temporal artery, supratrochlear artery/ supraorbital artery, facial artery and the blood supply diagram, as shown in Figure 1A-C, respectively), designed by retaining vascular pedicle and dissociating into island shape, are characterised by stable blood supply, flexible stretch and relative acceptable appearance because of the similarity appearance with facial skin. 8 Meanwhile, based on the medical characteristics, on the one hand, age pigment or nevus in elderly patients were more prone to deteriorate into periorbital malignancy, and on the other hand, cutis laxa senilis could enhance the availability and utilisation of the facial flaps, which would pose advantages over the young.…”

“…Local advancement or rotation flaps have their limited repair coverage as the invariable perfusion of the blood supply. Although the free‐flap reconstruction for secondary wounds poses adopted operating mode currently, this time‐consuming surgery with a certain additional trauma at the donor site, long recovery time or underlying risk of embolism brings about negative elements for the reconstruction outcomes, leaving uncertain issues to clinicians 3,7 …”

"Use of a Dermal Regeneration Template in the Multi- Flap Reconstruction of a Total Upper and Lower Eyelid Defect"

“…On the other hand, it is very difficult to find a tissue that can adequately cover the eyeball [2,3]. Several surgical techniques, ranging from the use of local, pedicled or free flaps, to the use of simple or composite grafts, have been proposed in the available literature; however, none of these techniques have been proven to be clearly superior to the other [2][3][4].The Dermal Regeneration Template (DRT; Integra Ⓡ Dermal Regeneration Template, Integra LifeSciences Corporation, from the treatment of scar contractures to the reconstruction of soft tissues loss due to trauma or cancer removal in all anatomical sites. In this report, we describe the first surgical case of a multilayered composite mucosal graft and flaps reconstruction of wide eyelid defects covered by using a DRT for the upper eyelid.…”