Tenzel semicircular flap technique for reconstruction of defects in lower eyelid

Abstract

Objective: To evaluate the results of the semicircular flap technique used in repair of lower eyelid defects occuring after tumor excision. Methods: Twenty one cases whose lower eyelids were repaired with semicircular flap after tumor excision were evaluated retrospectively. Cases for whom additional surgical techniques besides semicircular flap for repair of the defect were applied and followed-up for less than 6 months were ex- cluded from the study. Thirteen were female and 8 were male, ages were between 43 and 79 (mean 60.3 years). Surgical excision material contained 4 mm intact tissue. Eyelid reconstruction was made with Tenzels semicircular flap. The patients were evaluated according to size of the tumor and defect after excision and postoperative complications, eyelid function, cosmetic appearance and the need for secondary surgery. Cold was applied to the region because periorbital hematoma and edema was thus reduced in the postoperative period (48-hour). Patients were xamined postopera- tive 1. day, 1. week, 1. month and then monthly. Skin sutures were removed 1 week later. Postoperative medical treatment; 1 week of oral antibiotics (amoxicillin + clavulanic acid 1000 mg 2x1) with analgesic and anti-inflammatory (naproxen sodium 550 mg, 2x1) used by the patient. All of the patients used topical antibiotic tobramycin drops of 3 mg/mL, 5x1 for the first week. Results: Nineteen patients had basal cell carcinoma, 2 patients had squamous cell carcinoma. On the horizontal axis, the average tumor size was 5.6±0.5 mm (2-10 mm), the average defect size was 12.3±1.1 mm (11-18 mm). With this method, eyelid repair was achieved in all cases, t and eyelid functions were preserved. Postoperatively, 19 patients (90.5%) cases achieved a satisfactory appearance of the eyelid in the judgment of the surgeon. Surgical complications were recorded in 5 cases (24%). Lateral canthal webbing in 2 cases (10%), trichiasis and lid margin notch 1 patient (5%) and pyogenic granuloma in 2 cases (10%) were observed. The mean duration of follow-up was 13.3±4.1 month (6-18 month). Eyelid defects were primarily reconstructed in all patients during surgery. Functions of the lower eyelid returned to normal after ecchymosis and edema recovered.Appearance of the eyelid was satisfactory in the judgment of the surgeons in 19 of 21 cases (90.5%). Conclusion: Repair with semicircular flap in lower lid defects was very satisfactory in terms of eyelid function and cosmetic appearance. It is a tech- nique that has fewer complications and does not require serious secondary surgery. Repair with the semicircular flap is an efficient and reliable method in appropriate lower eyelid defects.

Özet

Amaç: Alt göz kapağı tümör eksizyonu sonrası oluşan defektlerin onarımında kullanılan semisirküler flep tekniğinin sonuçlarını değerlendirmek. Yöntemler: Alt göz kapağı tümör eksizyonu sonrası semisirküler flep ile göz kapağı onarımı yapılan 21 olgu retrospektif olarak değerlendirildi. Defektin onarımında semisirküler flep yanında ek cerrahi teknikler kullanılan olgular ve postoperatif 6 aydan kısa takipli olgular çalışmaya dahil edilmedi. Hastaların 13ü kadın, 8i erkek olup, ortalama yaş 60.3±7.4 (43-79 yaş) idi. Cerrahi eksizyon kötü huylu tümörlerde 4 mm sağlam doku içerdi. Kapak rekonstrüksiyonu Tenzelin semisirküler flep tekniği ile yapıldı. Olgular, tümörün ve eksizyon sonrası oluşan defektin büyüklüğü Yatay eksende; tümör büyüklüğü ortalama 5.6±0.5 mm (2-10 mm), defekt büyüklüğü ortalama 12.3±1.1 mm (11-18 mm) idi. Bulgular: Olguların 19unda bazal hücreli karsinom, 2sinde yassı hücreli karsinom mevcuttu. Yatay eksende; tümör büyüklüğü ortalama 5.6±0.5 mm (2-10 mm), defekt büyüklüğü ortalama 12.3±1.1 mm (11-18 mm) idi. Bu yöntem ile tüm olgularda kapak onarımı sağlandı, kapak fonksiyonları korundu. Postoperatif, cerrahın değerlendirmesine göre %90.5 olguda (19 hasta) tatminkar kapak görünümü sağlandı. Ödem ve ekimozun düzelmesi sonrasında alt göz kapağı fonksiyonları normale döndü. Toplam 5 olguda (%24) cerrahi komplikasyon kaydedildi. İki olguda (%10) lateral kantal perdelenme, 1 olguda (%5) trikiyazis ve kapak kenarında çentiklenme, 2 olguda (%10) piyojenik granülom görüldü. Hastaların izlem süresi ortalama 13.3±4.1 (6-18 ay) aydı. Sonuç: Alt kapak defektlerinde Tenzel semisirküler flep ile onarım kapak fonksiyonu ve kozmetik görünüm açısından oldukça tatmin edicidir. Komplikasyonları az olan ve ciddi ikincil cerrahi gerektirmeyen bir tekniktir. Semisirküler flep ile onarım uygun alt göz kapağı defektlerinde tercih edilebilecek etkin ve güvenilir bir cerrahi yöntemdir.