RU2729447C1 - Method of lower eyelid plasty - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention refers to medicine, namely surgery. Transposition skin-and-fat linguiform flap is cut out of skin of the upper eyelid of the same side, which is displaced downwards and fixed to the edges of the defect of the lower eyelid. Flap is cut out with width of 1.5 cm, and the apex of the flap is at the level of the lateral angle of the eye, and its base is 1 cm inward from the medial angle of the eye. After mobilization, the flap is displaced downwards, folded to form a duplicate, a distal edge of the flap skin inside, to the eyeball. It is sutured to the remains of the conjunctiva of the lower eyelid with a subconjunctival subcutaneous suture. Then monofilament is stretched and fixed between upper edges of lower eyelid defect. Flap is hung on filament, proximal edge, skin outward, anchored to skin edge of lower eyelid wound.EFFECT: method is single-stage, enables to reconstruct the whole thickness of the lower eyelid, including the ciliary carcass, to improve functional and aesthetic results of reconstruction of the extensive defect of the lower eyelid.1 cl, 1 dwg, 1 ex

Description

The invention relates to medicine, mainly to reconstructive surgery for common tumors of the skin of the lower eyelid, occupying its entire volume, invading the tarsal plate and conjunctiva.

There is a known method of plastics of a through subtotal defect of the lower eyelid, while from the lower eyelid of the opposite eye a full-thickness graft of appropriate sizes is excised, which is placed in the defect area and sutured with three rows of sutures (Patent of the Russian Federation No. 2375017 "Method of plastics of a through subtotal defect of the lower eyelid" / Klochikhin A L., Chistyakov AL (analogue) The disadvantage of this method is the use of a free graft, ie, a plastic material that does not have its own power source, which increases the risk of necrosis or trophic disorders from the transplanted material.

The closest in technical essence (prototype) is the method of M.L. Krasnova, described in 1988 (Guide to eye surgery, under the editorship of M.L. Krasnova, B.C. Belyaev, - Moscow: Medicine, 1988, S. 59-60). The essence of the method consists in the combined plasty of the through defect of the lower eyelid with a skin flap on the leg from the upper eyelid. With this technique, the skin part of the defect is eliminated with the help of an upper eyelid skin flap on a pedicle, which is sutured to the edges of the lower eyelid defect, the conjunctival defect is eliminated by simply bringing the edges of the wound closer together (first stage). After engraftment of the donor part of the flap, the second stage of the operation is required - excision of the stem stem. The disadvantages of this method are the two-stage intervention, as well as the fact that the conjunctival defect is eliminated by simply bringing the edges of the wound together, which is impossible with total or subtotal removal of the lower eyelid for a tumor.

The aim of the invention is to improve the functional and aesthetic results of reconstruction of an extensive defect in the lower eyelid.

The set goal is achieved by the fact that the transposition skin-fatty tongue-shaped flap cut from the skin of the upper eyelid of the same side, displaced downward and fixed to the edges of the defect of the lower eyelid, is pre-folded with the formation of a duplicate, the distal edge of the flap is skin inside, to the eyeball; sutured to the remnants of the conjunctiva of the lower eyelid with a subconjunctival-subcutaneous suture; then, between the upper edges of the sectoral defect of the lower eyelid, the monofilament is pulled and fixed like a "hanging rope"; the flap is hung on threads and the proximal edge, skin outward and sutured to the skin edge of the lower eyelid wound.

The proposed method of lower eyelid plastics is performed as follows.

Under endotracheal anesthesia, the tumor-affected part of the lower eyelid is excised throughout the entire thickness, including its tarsal part and the conjunctiva. From the skin of the upper eyelid of this side, a transposition skin-fatty tongue-shaped flap 1.5 cm wide is cut out, while the top of the flap is at the level of the lateral angle of the eye, and its base is 1 cm inward from the medial angle of the eye. After mobilization, the flap is displaced from top to bottom, folded to form a duplicator, the distal edge of the flap with the skin inside (to the eyeball) is sutured to the remnants of the conjunctiva of the lower eyelid with a subconjunctival-subcutaneous suture with a thin absorbable suture material (Maxon 5-0) to avoid irritation of the cornea. Then, between the upper edges of the sectoral defect of the lower eyelid, a monofilament (like a "hanging rope") is pulled and fixed, the flap is hung on the threads and the proximal edge is sutured with the skin outward to the skin edge of the lower eyelid wound. The resulting skin duplication imitates the lower eyelid, and the thread stretched between the leaves replaces the hard ciliary edge of the lower eyelid. The donor wound on the upper eyelid is sutured with Prolen 5-0 suture, keeping the feeding pedicle in the medial corner of the eye. Skin sutures are removed for 6-7 days. The advantages of the proposed method are one-stage operation, the ability to recreate the entire thickness of the lower eyelid, including the frame of the ciliary edge. The use of a pedicle flap increases the likelihood of its successful engraftment and a good aesthetic result.

List of figures of explanatory materials:

FIG. 1. View of the reconstructed lower eyelid on the left one month after surgery.

Clinical example

Patient K., 51 years old, was admitted to the department on February 25, 2019, with complaints of the presence of a tumor of the lower eyelid on the left. On examination, a tumor in the form of a lumpy infiltrate occupies the entire 2/3 of the ciliary edge of the lower eyelid on the left and all its layers grow. From the anamnesis: she has been ill since November 2018, when she first discovered a tumor process in the lower eyelid on the left. I went to the oncologist, a scraping was taken, the diagnosis was verified: Basal cell carcinoma. Surgical treatment was proposed. 02/26/19 the operation was performed: Excision of the tumor of the lower eyelid on the left with plastic transposition skin and fat flap from the upper eyelid. The part of the lower eyelid affected by the tumor was excised under endotracheal anesthesia. Hemostasis. From the skin of the upper eyelid on the same side, a transposition skin-fatty tongue-shaped flap 1.5 cm wide was cut out, while the top of the flap is at the level of the lateral angle of the eye, and its base is 1 cm medially from the medial angle of the eye. After mobilization, the flap is displaced from top to bottom, folded with the formation of a duplicate, the distal edge of the flap with the skin inward (to the eyeball) is sewn to the remnants of the conjunctiva of the lower eyelid with a subconjunctival-subcutaneous suture. Further, between the upper edges of the sectoral defect of the lower eyelid, a monofilament thread (like a "hanging rope") is stretched and fixed, the flap is hung on the threads and the proximal edge is sutured with the skin outward to the skin edge of the lower eyelid wound. The donor wound in the upper eyelid was sutured with Prolen 5-0 thread. Primary wound healing. The stitches were removed from the skin on the 10th day.

The proposed method for lower eyelid plastics is used in stationary conditions of the Yaroslavl Regional Clinical Oncological Hospital.

Claims (1)

The method of plastics of the lower eyelid, which consists in the fact that a transposition skin-fatty tongue-shaped flap is cut out from the skin of the upper eyelid of the same side, which is displaced downward and fixed to the edges of the defect of the lower eyelid, characterized in that the flap is cut out 1.5 cm wide, while the top of the flap is at the level of the lateral angle of the eye, and its base is 1 cm medially from the medial angle of the eye, after mobilization, the flap is displaced downward, folded to form a duplicator, the distal edge of the flap is skin inward, to the eyeball; sutured to the remnants of the conjunctiva of the lower eyelid with a subconjunctival-subcutaneous suture; then, between the upper edges of the lower eyelid defect, the monofilament is pulled and fixed; the flap is hung on a thread, the proximal edge, skin outward, sutured to the skin edge of the lower eyelid wound.

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