RU2375017C1 - Method of through subtotal defect of inferior eyelid plastics - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, mainly to reconstructive operations of widespread tumors of inferior eyelid skin, growing through all its layers. In order to reconstruct defect, free fully-layered transplant of wedge-shaped form from inferior eyelid of opposite eye taken in all eyelid thickness is used. Fixation of transplant to donor region is realised by three lines of sutures: intermarginal, subconjunctival and skin. Operation is carried out with endotracheal anesthesia.

EFFECT: method ensures simultaneous defect closing, recreation of ciliary eyelid border, improvement of functional and esthetic results of reconstruction of through defects of inferior eyelid, reduction of post-operation complications, reduction of treatment terms.

4 dwg, 1 ex

Description

The invention relates to medicine, mainly to reconstructive operations for common tumors of the skin of the lower eyelid, sprouting all its layers.

There is a known technique for plastic surgery of end-to-end subtotal defects of the lower eyelid described by J. Shah in 2003 (Shah J. Head and Neck Surgery and Oncology. Third Edition. - Mosby, New York. - 2003. - P.42-43, analogue). With this method of plasty, the lower eyelid defect is closed with a skin-fat flap from the parotid-temporal region according to Mustarde, rotated to the defect zone. The disadvantage of this method is that the hemming of the skin of the flap is made directly to the conjunctiva of the lower eyelid, which is very thin and mobile, resulting in an eversion of the eyelid. In addition, this method of plastics does not provide the presence of eyelashes on the edge of the skin flap, which is a cosmetic disadvantage.

The closest in technical essence is the method of M.L.Krasnov, described in 1988 (Manual on eye surgery, under the editorship of M.L. Krasnov, BC Belyaev, M .: Medicine, 1988, p. 59-60 prototype). The essence of the method lies in the combined plastic of the through defect of the lower eyelid with a flap of skin on the leg formed in the region of the upper eyelid. With this method, the defect of the conjunctiva of the lower eyelid is eliminated by simply converging the edges of the wound, which makes it impossible to use this method for plastic defects of the lower eyelid exceeding two-thirds of its length. The skin part of the defect is eliminated with a flap of the skin of the upper eyelid on the leg (acute microstem), which is sutured to the edges of the defect of the skin of the lower eyelid (first stage). After the donor part of the flap has taken root, the second stage of the operation is necessary - excision of the stem leg. Like the previous method, this technique does not solve the problem of eyelash defect, the restoration of which is a difficult problem.

The objective of the invention is to improve the functional and aesthetic results of the reconstruction of through defects of the lower eyelid. This technical result is achieved as follows.

Under endotracheal anesthesia after excision of a tumor of the lower eyelid (Fig. 1) by resection of the greater part of the entire thickness (only sections of the lower eyelid along the edges up to 5-6 mm long are preserved) and hemostasis of the wound edges by electrocoagulation, a through wedge-shaped section from the central part of the lower eyelids of a healthy eye (figure 2), while the length of the ciliary edge of the free graft is 1.2 cm, the height of the graft corresponds to the height of the defect after excision of the tumor. The graft is placed in the area of the defect and is fixed to the edges of the wound using sutures, while the intermarginal edges of the recipient area and the graft are combined on both sides so as to accurately match the growth lines of the eyelashes. Submucosal (subconjunctival) and skin sutures are then applied. A donor wound is sutured by simply converging the edges of the wound. The threads of the sutures that fix the ciliary edges of the wound surfaces are fixed to the skin with a band-aid in order to avoid corneal irritation (Fig. 3). A month after the operation, complete engraftment of the free graft is observed with partial preservation of eyelashes and a good cosmetic effect (Fig. 4). The advantages of the proposed method are one-stage operation, the ability to recreate the ciliary edge of the eyelid. Unlike other methods of plasty of defects of the lower eyelid, the method is more physiological, since the defect is filled with a graft similar in anatomical structure and color. The appearance and function of a healthy eye do not suffer.

The list of figures illustrating materials

Figure 1.

Illustrates the appearance of a lower eyelid tumor on the right before surgery.

Figure 2.

Illustrates section marking before surgery.

Figure 3.

Demonstrates the appearance of postoperative sutures on the lower eyelid.

Figure 4.

The appearance of the patient a month after the operation.

An example implementation of the claimed method

We give the following observation as an example. Patient L., 70 years old, was admitted to the department on 10.24.2007, and. No. 8103, with complaints of a tumor on the lower eyelid on the right. On examination, a tumor in the form of a tuberous whitish infiltrate, occupying the middle part of the lower eyelid on the right and germinating all its layers. From the anamnesis: sick for about a year. The result of cytological examination before surgery No. 7145 of 08/10/07: Basal cell carcinoma. 10/25/07 the operation was performed: Excision of a tumor of the lower eyelid on the right with plastic surgery with a free full-layer flap from the lower eyelid on the left. Under endotracheal anesthesia, a wedge-shaped portion of the right lower eyelid with a tumor was excised, departing from the edge of the tumor 2 mm, hemostasis. A wedge-shaped section is excised from the middle third of the left lower eyelid (the length of the intermarginal edge of the graft is 1.2 cm). A free graft was placed on the defect, fixed in the ciliary region on both sides by Prolen 6-0, 3 submucosal (subconjunctival) sutures were applied Maxon 5-0, sutures on the skin Prolen 7-0. The donor wound is sutured by converging the edges of the wound, sutures Prolen 6-0. The postoperative period without complications. A month after the operation - complete engraftment of a free transplant, a good aesthetic result.

Claims (1)

The method of plasty of a through subtotal defect of the lower eyelid with the reconstruction of all its layers, characterized in that, for the purpose of reconstruction of the defect, a free full-layer wedge-shaped graft is used from the lower eyelid of the opposite eye, taken to the entire eyelid thickness, the graft is fixed to the donor site in three rows of sutures : intermarginal, subconjunctival and cutaneous; the operation is performed under endotracheal anesthesia.

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