Download PDF
Facial Plast Surg 2014; 30(05): 561-569
DOI: 10.1055/s-0034-1395264
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Reconstruction of Periorbital Soft Tissue Defects

Jens U. Berli
1   Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
,
Shannath L. Merbs
2   Division of Oculoplastic Surgery, Department of Ophthalmology, Wilmer Eye Institute at Johns Hopkins, Baltimore, Maryland
,
Michael P. Grant
1   Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
2   Division of Oculoplastic Surgery, Department of Ophthalmology, Wilmer Eye Institute at Johns Hopkins, Baltimore, Maryland
› Author Affiliations
Further Information

Publication History

Publication Date:
14 November 2014 (online)

    Permissions and Reprints

Abstract

Because of the complex anatomy and fine mechanics of the periorbital soft tissues, the reconstruction of this region can be particularly daunting. Through a structured assessment of the defect, based on subunit analysis and thorough understanding of the surgical layers, we believe to allow the reconstructive surgeon to develop an algorithmic approach to these complex problems. The sequela of a suboptimal reconstruction do not only result in an inferior aesthetic result, but also have the potential for long-term functional problems such as epiphora, dry eye, ptosis, eyelid retraction, and thus requiring secondary surgery. There is no better time to aim for a perfect reconstruction than at the time of the initial surgery. In this chapter, we hope to encourage the reader to strengthen and recapitulate these analytical skills and present the most commonly used and studied techniques to help achieve a reproducible functional and aesthetically appealing result.

Keywords

periorbital - soft tissue - reconstruction - eyelid - lacrimal
 

  • References

  • 1 Morley AMS, deSousa J-L, Selva D, Malhotra R. Techniques of upper eyelid reconstruction. Surv Ophthalmol 2010; 55 (3) 256-271
    CrossrefPubMedGoogle Scholar
  • 2 Mathijssen IMJ, van der Meulen JC. Guidelines for reconstruction of the eyelids and canthal regions. J Plast Reconstr Aesthet Surg 2010; 63 (9) 1420-1433
    CrossrefPubMedGoogle Scholar
  • 3 Sassoon EM, Codner MA. Eyelid reconstruction. In: Menick FJ, , ed. Operative Techniques in Plastic and Reconstructive Surgery. Philadelphia, PA: WB Saunders; 1999. ; 6(4): 250-264
    Google Scholar
  • 4 Rosenstein T, Talebzadeh N, Pogrel MA. Anatomy of the lateral canthal tendon. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000; 89 (1) 24-28
    CrossrefPubMedGoogle Scholar
  • 5 Mustardé JC. Application of plastic surgery principles in the orbital region. Trans Ophthalmol Soc U K 1976; 96 (1) 35-38
    PubMedGoogle Scholar
  • 6 Leibovitch I, Huilgol SC, Hsuan JD, Selva D. Incidence of host site complications in periocular full thickness skin grafts. Br J Ophthalmol 2005; 89 (2) 219-222
    CrossrefPubMedGoogle Scholar
  • 7 Kenkel JM. Eyelid reconstruction. In: Selected Readings in Plastic Surgery. Dallas, TX: SRPS Inc; 2000. : 9, (14): 1-42
    Google Scholar
  • 8 Tenzel RR, Stewart WB. Eyelid reconstruction by the semicircle flap technique. Ophthalmology 1978; 85 (11) 1164-1169
    CrossrefPubMedGoogle Scholar
  • 9 Paridaens D, van den Bosch WA. Orbicularis muscle advancement flap combined with free posterior and anterior lamellar grafts: a 1-stage sandwich technique for eyelid reconstruction. Ophthalmology 2008; 115 (1) 189-194
    CrossrefPubMedGoogle Scholar
  • 10 Cutler NL, Beard C. A method for partial and total upper lid reconstruction. Am J Ophthalmol 1955; 39 (1) 1-7
    CrossrefPubMedGoogle Scholar
  • 11 Hsuan J, Selva D. Early division of a modified Cutler-Beard flap with a free tarsal graft. Eye (Lond) 2004; 18 (7) 714-717
    CrossrefPubMedGoogle Scholar
  • 12 Mauriello Jr JAJ, Antonacci R. Single tarsoconjunctival flap (lower eyelid) for upper eyelid reconstruction (“reverse” modified Hughes procedure). Ophthalmic Surg 1994; 25 (6) 374-378
    PubMedGoogle Scholar
  • 13 Leone Jr CRJ. Tarsal-conjunctival advancement flaps for upper eyelid reconstruction. Arch Ophthalmol 1983; 101 (6) 945-948
    CrossrefPubMedGoogle Scholar
  • 14 Esser JFS. Transplanting a vertically placed pedicled wedge from the upper to the lower lid or vice versa. Klin Montasbl Augenh 1919; 63: 379
    PubMedGoogle Scholar
  • 15 Mustardé JC. Reconstruction of eyelids. Ann Plast Surg 1983; 11 (2) 149-169
    CrossrefPubMedGoogle Scholar
  • 16 Elliot D, Britto JA. Tripier's innervated myocutaneous flap 1889. Br J Plast Surg 2004; 57 (6) 543-549
    CrossrefPubMedGoogle Scholar
  • 17 Callahan A. The free composite lid graft. AMA Arch Opthalmol 1951; 45 (5) 539-545
    CrossrefPubMedGoogle Scholar
  • 18 Werner MS, Olson JJ, Putterman AM. Composite grafting for eyelid reconstruction. Am J Ophthalmol 1993; 116 (1) 11-16
    CrossrefPubMedGoogle Scholar
  • 19 Putterman AM. Viable composite grafting in eyelid reconstruction. Am J Ophthalmol 1978; 85 (2) 237-241
    CrossrefPubMedGoogle Scholar
  • 20 Cannon PS, Madge SN, Kakizaki H, Selva D. Composite grafts in eyelid reconstruction: the complications and outcomes. Br J Ophthalmol 2011; 95 (9) 1268-1271
    CrossrefPubMedGoogle Scholar
  • 21 Hammer B. Orbital fractures: Diagnosis Operative Treatment, Secondary Corrections. 1st ed. Cambridge, MA: Hogrefe & Huber; 1995
    Google Scholar
  • 22 Engelstad ME, Bastodkar P, Markiewicz MR. Medial canthopexy using transcaruncular barb and miniplate: technique and cadaver study. Int J Oral Maxillofac Surg 2012; 41 (10) 1176-1185
    CrossrefPubMedGoogle Scholar
  • 23 Weinstein GS, Anderson RL, Tse DT, Kersten RC. The use of a periosteal strip for eyelid reconstruction. Arch Ophthalmol 1985; 103 (3) 357-359
    CrossrefPubMedGoogle Scholar
  • 24 Naik MN, Kelapure A, Rath S, Honavar SG. Management of canalicular lacerations: epidemiological aspects and experience with Mini-Monoka monocanalicular stent. Am J Ophthalmol 2008; 145 (2) 375-380
    CrossrefPubMedGoogle Scholar
  • 25 Merbs SL, Harris LL, Iwamoto MA, Iliff NT. Prevention of prolapsed silicone stents in lacrimal intubation using an intrasac fixation suture. Arch Ophthalmol 1999; 117 (8) 1092-1095
    CrossrefPubMedGoogle Scholar