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Published in: European Journal of Plastic Surgery 1/2020

01-02-2020 | Skin Graft | Case Report

Total upper and lower eyelid reconstruction using periosteal flap canthoplasty combined with auricular cartilage and oral mucosa grafts

Authors: Kaoru Sasaki, Yuki Fujita, Yukiko Imai, Junya Oshima, Masahiro Sasaki, Yukiko Aihara, Mitsuru Sekido

Published in: European Journal of Plastic Surgery | Issue 1/2020

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Abstract

Extensive full-thickness defects of both the upper and the lower eyelids continue to be a challenge for reconstructive surgeons. Ectropion of the lower eyelid and an unnatural canthal shape are pitfalls to be avoided in total eyelid reconstruction. We here present a case in which an extensive full-thickness defect of the upper and lower eyelids after tumor resection was successfully reconstructed by means of periosteal flap canthoplasty from the infraorbital margin. A 73-year-old woman had in situ melanoma on her left eyelids. The lids were almost completely removed as a result of tumor resection. The conjunctival defect was covered with oral mucosa. And the tarsal layer was reconstructed with auricular cartilage. A periosteal flap pedicled at the origin of the lateral canthal tendon was harvested from the infraorbital margin. The flap was fixed with sutures on the cartilage graft for the lower eyelid. The cartilage graft for the upper eyelid was sutured laterally on the basal portion of the periosteal flap as the lateral canthus. The skin defect of the upper eyelid was covered with a bipedicled orbicularis oculi flap and skin graft. The lower eyelid was reconstructed with a combination of an angular artery transposition flap and a cheek rotation flap. Thirteen months after the surgery, the reconstructed eyelids had good function without ectropion. And the reconstructed canthus had a natural sharp shape. Total eyelid reconstruction using periosteal flap canthoplasty combined with auricular cartilage and oral mucosa grafts is useful for extensive full-thickness defects of the upper and lower eyelids.
Level of evidence: Level V, therapeutic study.
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Metadata
Title
Total upper and lower eyelid reconstruction using periosteal flap canthoplasty combined with auricular cartilage and oral mucosa grafts
Authors
Kaoru Sasaki
Yuki Fujita
Yukiko Imai
Junya Oshima
Masahiro Sasaki
Yukiko Aihara
Mitsuru Sekido
Publication date
01-02-2020
Publisher
Springer Berlin Heidelberg
Keyword
Skin Graft
Published in
European Journal of Plastic Surgery / Issue 1/2020
Print ISSN: 0930-343X
Electronic ISSN: 1435-0130
DOI
https://doi.org/10.1007/s00238-019-01556-4

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