Eyelid Reconstruction Techniques
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What is the primary advantage of direct layered closure?

  • It is a less invasive procedure that requires less tissue
  • It is a more complex procedure that requires less expertise
  • It provides a more extensive reconstruction of the eyelid
  • It leaves an intact lid margin with a full lash line (correct)

    • What is the purpose of covering the anterior lamella with thin skin?

  • To provide additional structural support to the eyelid
  • To enhance the appearance of the eyelid
  • To reduce the risk of lagophthalmos
  • To allow for complete eyelid closure and prevent corneal exposure (correct)

    • What is the role of the circumferential muscle layer in eyelid closure?

  • To provide internal stability to the eyelid
  • To prevent lagophthalmos and corneal exposure (correct)
  • To enhance the appearance of the eyelid
  • To elevate the lid above the visual axis

    • What is the primary source of mucous membrane for grafting?

    <p>The oral cavity</p> Signup and view all the answers

    What is the purpose of internal support in eyelid reconstruction?

    <p>To provide marginal stability and intimate corneal contact</p> Signup and view all the answers

    What is the alternative to local flaps when they are not possible?

    <p>Free skin grafts</p> Signup and view all the answers

    What is the primary advantage of using eye bank scleral grafts?

    <p>They are readily available and provide internal stability</p> Signup and view all the answers

    What is the primary function of vertical retraction in eyelid reconstruction?

    <p>To elevate the lid above the visual axis</p> Signup and view all the answers

    What is the shape of the vertical edges of the tarsal plates when closed?

    <p>Pentagon</p> Signup and view all the answers

    What type of suture is used to pass through the lid margin and lash line?

    <p>6-0 silk</p> Signup and view all the answers

    What is the purpose of the marginal sutures?

    <p>To evert the wound edge</p> Signup and view all the answers

    Why is it important to leave the marginal sutures long?

    <p>To prevent corneal abrasion</p> Signup and view all the answers

    What is the purpose of the reverse-Frost traction suture?

    <p>To put the lid on stretch</p> Signup and view all the answers

    What is the consequence of not extending the pentagonal shape of the tarsal plates?

    <p>Notching</p> Signup and view all the answers

    What is the recommended frequency for applying antibiotic ointment to the sutures?

    <p>Three times daily for 7 days</p> Signup and view all the answers

    What is the purpose of performing a lateral canthotomy?

    <p>To reduce tension on the wound</p> Signup and view all the answers

    What is the main purpose of the Cutler-Beard procedure?

    <p>To reconstruct small to medium eyelid defects</p> Signup and view all the answers

    In which year was the article 'A method for partial and total upper lid reconstruction' published?

    <p>1955</p> Signup and view all the answers

    What is the name of the procedure used for reconstructing large upper lid defects?

    <p>Double Bridged Flap Upper Eyelid Reconstruction</p> Signup and view all the answers

    What is the material used for grafting in lower eyelid retraction?

    <p>Autogenous auricular cartilage</p> Signup and view all the answers

    Who wrote the article 'Experience in upper eyelid reconstruction with the Cutler-Beard technique'?

    <p>Fischer, Noever, Langer, and Kammer</p> Signup and view all the answers

    What is the main indication for the Direct Layered Closure of Marginal Eyelid Defects?

    <p>Reconstruction of small to medium eyelid defects involving the full-thickness lid margin</p> Signup and view all the answers

    What is the name of the procedure used for the management of ectropion?

    <p>Tarsoconjunctival composite graft</p> Signup and view all the answers

    What is the main purpose of the Double Bridged Flap Upper Eyelid Reconstruction?

    <p>To perform non-marginal, full-thickness upper eyelid reconstruction</p> Signup and view all the answers

    What is the initial direction of the incision when making a vertical cut from the ends of the horizontal incision?

    <p>Medially and upward</p> Signup and view all the answers

    What is the purpose of passing a grooved director beneath the ap?

    <p>To cut across the ap 2 mm below the desired position of the new upper lid margin</p> Signup and view all the answers

    What is the material used to fashion a piece to fit the defect?

    <p>Autogenous auricular cartilage or donor sclera</p> Signup and view all the answers

    What is the purpose of trimming 2 mm of skin and muscle from the new upper eyelid margin?

    <p>To leave a ap of conjunctiva posteriorly</p> Signup and view all the answers

    What is the purpose of suturing the conjunctiva and lower lid retractors to the inferior border of the tarsus?

    <p>To provide support to the lower eyelid</p> Signup and view all the answers

    What is the direction of advancement of the conjunctival ap?

    <p>Medially and upward</p> Signup and view all the answers

    What is the purpose of undermining the lateral and medial edges of the cheek incisions?

    <p>To expose all lamellae</p> Signup and view all the answers

    What is the type of stitch used to suture the conjunctiva to the skin edge?

    <p>7-0 chromic stitch</p> Signup and view all the answers

    What is a common outcome following separation in eyelid reconstruction?

    <p>Prolonged edema</p> Signup and view all the answers

    Why is attention to vertical suspension of the lower eyelid crucial?

    <p>To maintain internal stability and canthal ligament support</p> Signup and view all the answers

    What is the significance of reconstructing anterior and posterior lamellae with appropriate tissue?

    <p>To restore eyelid function</p> Signup and view all the answers

    What is the role of gravity in lower eyelid reconstruction?

    <p>It can cause eyelid sagging</p> Signup and view all the answers

    What is the purpose of periosteal fixation in lower eyelid reconstruction?

    <p>To maintain internal stability</p> Signup and view all the answers

    What is the significance of secondary reduction of eyelid length?

    <p>It is often necessary in eyelid reconstruction</p> Signup and view all the answers

    What is the common complication following reconstructed eyelids?

    <p>Persistent edema</p> Signup and view all the answers

    What is the significance of surgical and anatomic principles in eyelid reconstruction?

    <p>They apply equally to upper and lower eyelid reconstruction</p> Signup and view all the answers

    ¿Cuál es el resultado común después de la separación en la reconstrucción de la párpada?

    <p>Ptosis</p> Signup and view all the answers

    ¿Cuál es el propósito de dejar los puntos marginales en su lugar durante 7 a 10 días?

    <p>Para permitir la cicatrización del tejido</p> Signup and view all the answers

    ¿Qué es la causa principal del notching de la párpada?

    <p>Non-pentagonal sides to the defect</p> Signup and view all the answers

    ¿Qué tipo de suture se utiliza para retirar el Frost suture después de 3 a 4 días?

    <p>Sutura marginal</p> Signup and view all the answers

    ¿Cuál es el resultado esperado después de la reconstrucción de la párpada con la técnica de rotación semicircular lateral?

    <p>Lid stretches over several weeks</p> Signup and view all the answers

    ¿Qué es el propósito de la reconstrucción de la párpada con la técnica de rotación semicircular lateral?

    <p>Reconstruction of 30% to 50% upper eyelid defects</p> Signup and view all the answers

    ¿Qué es el resultado común después de la reconstrucción de la párpada con la técnica de cierre directo?

    <p>Ptosis</p> Signup and view all the answers

    ¿Qué es el propósito de extender las incisiones verticales desde la margen de la párpada hasta la bordura superior del tarsal?

    <p>Para formar una shape pentagonal</p> Signup and view all the answers

    ¿Cuál es el resultado de la tensión o laxitud vertical en la posición del párpado?

    <p>Todas las anteriores</p> Signup and view all the answers

    ¿Qué técnica se utiliza para cerrar defectos de hasta 60% del ancho del párpado?

    <p>Técnica de Enzel</p> Signup and view all the answers

    ¿Cuál es el propósito de reestablecer el soporte canthal en la reconstrucción del párpado?

    <p>Recuperar la posición del párpado</p> Signup and view all the answers

    ¿Qué se requiere en defectos de más del 30% a 40% del ancho del párpado?

    <p>Canthotomía y cantholisis</p> Signup and view all the answers

    ¿Qué es el resultado de la falta de atención a la posición del párpado en la reconstrucción?

    <p>Todas las anteriores</p> Signup and view all the answers

    ¿Cuál es el propósito de la técnica de Hughes?

    <p>Reconstruir la posición del párpado</p> Signup and view all the answers

    ¿Qué se requiere para cerrar defectos de más del 60% del ancho del párpado?

    <p>Una combinación de técnicas</p> Signup and view all the answers

    ¿Qué es el resultado de la tensión horizontal excesiva en la reconstrucción del párpado?

    <p>Todas las anteriores</p> Signup and view all the answers

    ¿Cuál es el propósito de realizar un segundo corte horizontal cerca de la parte superior del tarso?

    <p>Para excisionar un bloque rectangular con conjuntiva adherente</p> Signup and view all the answers

    ¿Cómo se debe colocar el injerto tarsoconjuntival en el defecto del receptor?

    <p>Con la superficie mucosa hacia el globo y los extremos de las glándulas meibomianas hacia la parte superior del párpado</p> Signup and view all the answers

    ¿Qué tipo de punto debe usarse para suturar los bordes del injerto al tarso?

    <p>Punto interrumpido de 6-0 Vicryl</p> Signup and view all the answers

    ¿Qué se debe hacer si el defecto se extiende hasta la parte superior del borde orbital?

    <p>Avanzar la aponeurosis del músculo orbicular hacia abajo</p> Signup and view all the answers

    ¿Cuál es el propósito de Unterminer la piel y el músculo en la esquina inferotemporal del defecto?

    <p>Para evitar que el defecto se vuelque</p> Signup and view all the answers

    ¿Cómo se debe tratar la piel y el músculo orbicular después de la intervención?

    <p>Cerrando la piel con puntos de 6-0 Vicryl y el músculo orbicular con puntos de 7-0 cromático</p> Signup and view all the answers

    ¿Cuál es el propósito de aplicar un apósito en los párpados durante 24 horas después de la intervención?

    <p>Para ayudar a la cicatrización</p> Signup and view all the answers

    ¿Cuál es el período de tiempo recomendado para aplicar ungüento antibiótico en los puntos de sutura?

    <p>7 días</p> Signup and view all the answers

    ¿Cuál es la causa principal de la dehiscencia de la herida?

    <p>Demasiada tensión en la herida marginal</p> Signup and view all the answers

    ¿Cuál es el propósito de utilizar suturas de Vicryl 5-0 para anclar el músculo orbicular?

    <p>Fijar el músculo orbicular al periostio de la órbita</p> Signup and view all the answers

    ¿Cuál es el nombre del procedimiento utilizado para reconstruir defectos en el párpado superior del 40% al 50%?

    <p>Colgajo tarsoconjuntival transposición horizontal</p> Signup and view all the answers

    ¿Cuál es el propósito de hacer un corte horizontal a través de la conjuntiva y el tarsus?

    <p>Para exponer la superficie tarsal</p> Signup and view all the answers

    ¿Cuál es el material utilizado para la fijación del tarsal ap en la reconstrucción del párpado?

    <p>Sutura de Vicryl 6-0</p> Signup and view all the answers

    ¿Cuál es la complicación que puede ocurrir si no se refija el párpado lateral?

    <p>Contorno irregular del margen del párpado</p> Signup and view all the answers

    ¿Cuál es el propósito de colocar una sutura de 4-0 de seda a través del tarsus?

    <p>Para fijar el tarsal ap</p> Signup and view all the answers

    ¿Cuál es la causa de un contorno irregular del margen del párpado?

    <p>Error en la técnica de cierre de la herida</p> Signup and view all the answers

    ¿Cuál es el rango de tamaño de los defectos oculares para los cuales se utiliza el procedimiento de Hughes?

    <p>De 80% a 100% del párpado inferior</p> Signup and view all the answers

    ¿Cuál es el beneficio principal del procedimiento de Hughes?

    <p>Excelentes resultados funcionales y cosméticos</p> Signup and view all the answers

    ¿Cuál es el tipo de injerto utilizado en la reconstrucción del párpado inferior?

    <p>Injerto tarsocojuntival</p> Signup and view all the answers

    ¿Cuál es el propósito del avance del flap tarsocojuntival en la reconstrucción del párpado inferior?

    <p>Reconstruir la parte inferior del párpado</p> Signup and view all the answers

    ¿Cuál es la ventaja de utilizar un flap tarsocojuntival en la reconstrucción del párpado inferior?

    <p>Ofrece resultados funcionales y cosméticos excelentes</p> Signup and view all the answers

    ¿Cuál es el nombre del procedimiento que combina el avance del flap tarsocojuntival con un injerto de piel libre?

    <p>Procedimiento de Modified Hughes</p> Signup and view all the answers

    ¿Cuál es el objetivo principal de la reconstrucción del párpado inferior?

    <p>Reconstruir la función y la forma del párpado inferior</p> Signup and view all the answers

    ¿Cuál es el nombre del autor que describió el procedimiento de reconstrucción del párpado inferior utilizando un flap tarsocojuntival?

    <p>Hughes</p> Signup and view all the answers

    Study Notes

    Eyelid Reconstruction

    • Eyelid reconstruction involves replacing damaged or missing tissue with autogenous grafts, including skin, muscle, conjunctiva, and cartilage.
    • Direct layered closure is used for small to medium eyelid defects involving the full-thickness lid margin.
    • The Cutler-Beard procedure is used for upper eyelid reconstruction, involving a circumferential muscle layer and vertical retraction with levator muscle or substitute.

    Direct Layered Closure

    • The wound is approximated without excessive tension, and the tarsal plates are closed with interrupted 6-0 Vicryl sutures.
    • The orbicularis muscle layer is closed with 6-0 Vicryl sutures, and the skin is closed with interrupted 6-0 silk stitches.
    • The marginal sutures are left long to prevent corneal abrasion.

    Cutler-Beard Procedure

    • The procedure is used for partial and total upper eyelid reconstruction.
    • The anterior lamella of the upper lid must be covered with thin skin, allowing complete eyelid closure.
    • A circumferential muscle layer is necessary for closure to prevent lagophthalmos and corneal exposure.
    • Internal stability is achieved with tarsal replacement using eye bank scleral grafts, autogenous auricular cartilage, or preserved fascia or cartilage.

    Lower Eyelid Reconstruction

    • The surgical and anatomic principles for upper eyelid reconstruction apply equally to the lower eyelid.
    • Separate reconstruction of anterior and posterior lamellae with appropriate tissue is essential.
    • Attention to vertical suspension of the lower eyelid by replacing internal stability and canthal ligament support is critical.

    Complications

    • Persistent edema is common following separation and typically resolves with time.
    • Upper eyelid ptosis may occur following separation and may require a secondary ptosis repair.

    Direct Layered Closure of Marginal Eyelid Defects

    • Direct closure of marginal eyelid defects typically results in a tight and somewhat ptotic lid, which resolves as the lid stretches over several weeks to months.
    • The primary cause of eyelid notching is non-pentagonal, pie-shaped sides to the defect to be closed.
    • Frost sutures are removed after 3 to 4 days, and skin sutures are removed after 1 week.
    • Marginal sutures are left in place for 7 to 10 days.

    Lateral Semicircular Rotation Flap (Tenzel)

    • Reconstruction of 30% to 50% upper eyelid defects that cannot be closed directly.
    • Prepare the upper eyelid defect by excising the lesion or freshening the wound edges to form a pentagonal shape.
    • Extend the vertical cuts from the lid margin to the upper border of the tarsus, converging at a point close to the superior fornix.
    • Mark a semicircular line beginning at the lateral canthal angle and arching downward and laterally to follow the curve of the opened upper eyelid margin.
    • Deep 5-0 Vicryl sutures are used to anchor the orbicularis muscle to the temporal aponeurosis to relieve tension on the wound.
    • Potential complications include wound dehiscence, poor eyelid margin contour, and angulation of the margin.

    Horizontal Tarsoconjunctival Transposition Flap

    • Reconstruction of 40% to 50% upper eyelid defects when there is insufficient laxity of adjacent tissue to mobilize myocutaneous flaps.
    • Place a 4-0 silk suture through the marginal eyelid tarsus adjacent to the defect, and evert the remaining lid over a Desmarres retractor to expose the tarsal surface.
    • Make a horizontal cut through the conjunctiva and the tarsus 3 to 4 mm from and parallel to the eyelid margin.
    • Suture the other free edge of the tarsal flap to the opposite side of the eyelid defect or to the remnant of the lateral canthal ligament with 6-0 Vicryl sutures.

    Upper to Lower Eyelid Tarsoconjunctival Advancement Flap (Hughes Procedure)

    • Technique requires meticulous attention to the eyelid margin, similar to direct closure of marginal defects.
    • Larger defects over 30% to 40% may require a lateral canthotomy and cantholysis.
    • For larger segments, a semicircular temporal flap (Tenzel flap) may allow closure of defects up to 60% of the horizontal lid length.
    • Tarsoconjunctival advancement flap from upper to lower lid (Hughes flap), combined with a free skin graft or myocutaneous flap, yields excellent functional and cosmetic results.

    Free Tarsoconjunctival Graft

    • Reconstruction of large lower eyelid defects.
    • Tarsoconjunctival flap supplementation: an approach to the reconstruction of large lower eyelid defects.
    • Tarsoconjunctival grafts and bipedicle skin-muscle flaps are used for lower lid reconstruction.

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    Description

    This quiz covers the different methods and procedures involved in reconstructing eyelid tissues, including direct layered closure and other options. It discusses the advantages and limitations of each approach.

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