While the principles of eyelid reconstruction are well-established, achieving good functional and aesthetic reconstruction remains challenging

Alessio D Inchingolo

Angelo M Inchingolo

Fabio M Abenavoli

Francesco Inchingolo

Gianna Dipalma

LM Di Francesco

Marco Tatullo

Massimo Marrelli

Roberto Corelli

Y Yoshimura

English

PubMed

While the principles of eyelid reconstruction are well-established, achieving good functional and aesthetic reconstruction remains challenging. This communication presents a technique that we used on a young patient with an eyelid defect following a thermal burn. The patient was operated on to reconstruct the entire upper eyelid using, as a posterior lamella, a mucochondrial autologous graft taken from the ala of the nose as a tarsus and conjunctiva substitutes that were sutured to the Elevator palpebrae superioris aponeurosis and muscle. On the other hand, to reconstruct the anterior lamella, which consists of skin and muscle, the surgeons used a myocutaneous temporal flap taken from the region immediately lateral to the external canthus of the palpebral region, and which, after being isolated following a drawing of the upper eyelid to be reconstructed, was rotated and then sutured to the posterior lamella using the orbicularis oculi muscle as a pedicle. © 2009 Inchingolo et al; licensee BioMed Central Ltd

Inchingolo F.

Tatullo M.

Abenavoli F. M.

Marrelli M.

Inchingolo A. D.

Corelli R.

Inchingolo A. M.

Dipalma G.

Archivio istituzionale della ricerca - Università di Bari

BioMed CentralssHead & Face MedicineOpen AcceShort reportUpper eyelid reconstruction: a short report of an eyelid defect following a thermal burnFrancesco Inchingolo*1, Marco Tatullo1, Fabio M Abenavoli2, Massimo Marrelli3, Alessio D Inchingolo1, Roberto Corelli1, Angelo M Inchingolo1 and Gianna Dipalma1Address: 1Department of Dental Sciences and Surgery, General Hospital, Bari, Italy, 2Department of Otorinolaringoiatry, Hospital "Fatebenefratelli", Rome, Italy and 3Department of Maxillofacial Surgery, Calabrodental, Crotone, ItalyEmail: Francesco Inchingolo* - f.inchingolo@doc.uniba.it; Marco Tatullo - marco.tatullo@libero.it; Fabio M Abenavoli - f.abenavoli@mclink.it; Massimo Marrelli - studiomarrelli@calabrodental.it; Alessio D Inchingolo - f.inchingolo@tin.it; Roberto Corelli - f.abenavoli@mclink.it; Angelo M Inchingolo - f.inchingolo@tin.it; Gianna Dipalma - giannadipalma@tiscali.it* Corresponding author    AbstractWhile the principles of eyelid reconstruction are well-established, achieving good functional andaesthetic reconstruction remains challenging.This communication presents a technique that we used on a young patient with an eyelid defectfollowing a thermal burn. The patient was operated on to reconstruct the entire upper eyelid using,as a posterior lamella, a mucochondrial autologous graft taken from the ala of the nose as a tarsusand conjunctiva substitutes that were sutured to the Elevator palpebrae superioris aponeurosis andmuscle. On the other hand, to reconstruct the anterior lamella, which consists of skin and muscle,the surgeons used a myocutaneous temporal flap taken from the region immediately lateral to theexternal canthus of the palpebral region, and which, after being isolated following a drawing of theupper eyelid to be reconstructed, was rotated and then sutured to the posterior lamella using theorbicularis oculi muscle as a pedicle.IntroductionWhile the principles of eyelid reconstruction are well-established, achieving good functional and aestheticreconstruction remains challenging (1).A variety of techniques are now available, depending onthe type of lesion and its cause. This communicationpresents a technique that we used on a young patient withan eyelid defect following a thermal burn, which werecently encountered.Case ReportThe 37 year-old patient from a small town in northernItaly, was welding when he was hit by a spray of liquidmetal on the periorbital region that burned the upper eye-lid and part of the lower eyelid. The patient was treated byeye-specialists at the local hospital with multiple debride-ments of the palpebral lesions, that take several weeks toheal, save for the complete loss of the upper eyelid, albeitpartially maintaining the medial and lateral canthus,along with a loss of the ciliary margin of the entire lowerPublished: 25 November 2009Head & Face Medicine 2009, 5:26 doi:10.1186/1746-160X-5-26Received: 10 October 2009Accepted: 25 November 2009This article is available from: http://www.head-face-med.com/content/5/1/26© 2009 Inchingolo et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Page 1 of 3(page number not for citation purposes)Head & Face Medicine 2009, 5:26 http://www.head-face-med.com/content/5/1/26eyelid. In the weeks which followed, the inflammation ofthe eyeball, which was undamaged by the metal but irri-tated due to a lack of palpebral protection, worsened fur-ther, partially compromising the eye's functionality. So,surgery was scheduled to reconstruct the eyelid in a singleoperation, because of the distance the patient had totravel, which would also provide satisfactory functionaland aesthetic results. The patient was operated on toreconstruct the entire upper eyelid using, as a posteriorlamella, a mucochondrial autologous graft taken from theala of the nose as a tarsus and conjunctiva substitutes thatwere sutured to the levator palpebraesuperioris aponeurosis and muscle. On the other hand, toreconstruct the anterior lamella, which consists of skinand muscle, the surgeons used a myocutaneous temporalflap taken from the region immediately lateral to theexternal canthus of the palpebral region, and which, afterbeing isolated following a drawing of the upper eyelid tobe reconstructed (Fig. 1), was rotated and then sutured tothe posterior lamella using the orbicularis oculi muscle asa pedicle. The donor area was closed, following the ampleundermining of the edges, with a linear scar (hardlynoticeable) on the temporal area. The incision performedon the lower palpebral rim, necessary for the preparationof the orbicularis muscle as a myocutaneous temporalflap, was used to place a composite graft taken from theright auricular concha in order to lift and provide greatersupport for the lower eyelid. The patient's postoperativerecovery was normal, and within 7 days he was able toreturn home, to be cared for once more by local eye-spe-cialists in continuing his medical treatment of the eyeball.When the patient returned two months later for a check-up, the aesthetic and functional result appeared satisfac-tory. In fact, the new upper eyelid with a stable lid margincould open and close properly in spite of the ongoingpresence of residual edema (Fig. 2 a-b).DiscussionWe, thus, consider the possible use of the myocutaneoustemporal flap as a substitute for the anterior lamella of theupper eyelid in the reconstruction of the complete eyelidto be extremely satisfactory. Thanks to the fact that theorbicularis oculi muscle beyond the orbital margins cov-ers the surface of the frontalis, temporalis, and other mus-cles, this pedicle, previously mentioned by Yoshimura etal. in 1991 (2), provides the possibility of further transfer-ring orbicularis muscle to the missing area when it is notpossible to use the lower eyelid as a donor area, with skinwhose characteristics are similar to those of the upper eye-Postoperative result two months later, with palpebra that can move up (2a) and down (2b)Figure 2Postoperative result two months later, with palpebra that can move up (2a) and down (2b).A BDrawing of the orbicularis oculi myocutaneous flap and surgi-cal incisionsFigure 1Drawing of the orbicularis oculi myocutaneous flap and surgical incisions.Page 2 of 3(page number not for citation purposes)Head & Face Medicine 2009, 5:26 http://www.head-face-med.com/content/5/1/26Publish with BioMed Central   and  every scientist can read your work free of charge"BioMed Central will be the most significant development for disseminating the results of biomedical research in our lifetime."Sir Paul Nurse, Cancer Research UKYour research papers will be:available free of charge to the entire biomedical communitypeer reviewed and published immediately upon acceptancecited in PubMed and archived on PubMed Central yours — you keep the copyrightSubmit your manuscript here:http://www.biomedcentral.com/info/publishing_adv.aspBioMedcentrallid and with absolutely sure vascularization since it con-tains branches of the angular artery and the infraorbitalartery in its pedicle. Making use of a muco-cartilaginousgraft taken from the ala of the nose is also advantageous,since it reproduces the firmness and features of the poste-rior lamella formed by the tarsal plate and the conjunc-tiva, without altering either the functionality or theaesthetics of the ala of the nose.ConclusionWe, therefore, believe our experiences, which can easily bereproduced in cases of total or subtotal full-thicknessdefects of the upper eyelid, will be of interest.ConsentWritten informed consent was obtained from the patientfor publication of this case report and accompanyingimages. A copy of the written consent is available forreview by the Editor-in-Chief of this journal.Competing interestsThe authors declare that they have no competing interests.Authors' contributionsFI: conceived of the study and participated in its designand coordination; MT: drafted the manuscript and partic-ipated in the design of the study; FMA: conceived of thestudy and participated in its design and execution; MM:participated in the design of the study; ADI: revised the lit-erature sources; RC: participated in design and executionof the study; AMI: documented surgery with digital pic-tures; GD: participated in the design of the study; Allauthors read and approved the final manuscript.;References1. Di Francesco , Lisa MMD, Codner , Mark AMD, McCord , ClintonDMD: Upper Eyelid Reconstruction.  Plastic & Reconstructive Sur-gery 2004, 114(7):98e-107e.2. Yoshimura Y, Nakajima T, Yoneda K: Reconstruction of theentire upper eyelid area with a subcutaneous pedicle flapbased on the orbicularis oculi muscle.  Plastic & ReconstructiveSurgery 1991, 88(1):136-9.Page 3 of 3(page number not for citation purposes)

Upper eyelid reconstruction: A short report of an eyelid defect following a thermal burn

Thyroid microcarcinomas (TMC) are histologically malignant diseases, despite their limited dimensions and non-aggressive behaviour; frequent multifocality of the disease and local recurrence is really possible after conservative resection. Modern therapeutic approaches to thyroid microcarcinoma include both radical surgical treatment, influenced by the frequent locoregional diffusion of TMC, consisting of a total thyroidectomy with an eventual central and/or functional unilateral lymphadenectomy, depending on the clinical evidence of lymh node metastases and conservative treatment based on more limited resections which take into account the slow clinical progression of this type of tumour. The aim of our work is to examine the therapeutic guidelines for surgical treatment of TMC which, in our experience, are closely dependent on clinical presentation type. From 1991 to 2000, more than 400 patients with thyroid disease were referred to the Department of Surgical Science and Applied Medical Technologies "F. Durante". Threehundred-seventythree patients received surgical treatment: in 311 patients a benign disease was diagnosed, while in 62 neoplasia was present. In total we observed 30 TMC, consisting of 28 papillary and 2 follicular microcarcinomas. On the basis of clinical presentation we divided patients in three groups: A--patients with a clinically suspicious neoplastic lesion before surgical treatment; B--patients in whom histological diagnosis of cancer was "incidental" after an operation performed for benign disease; C--patients in whom a neck lymph node metastases were clinically found before diagnosis of an "occult" papillary carcinoma in the thyroid gland. 27 total thyroidectomies and 3 conservative resections, that required successive total exeresis, were performed. In 5 cases a central neck lymph node dissection was carried out and in 5 + 1 cases functional modified lateral neck dissections was deemed necessary. Our data suggest that an evaluation of tumor's malignancy cannot be carried out on the basis of its dimensions alone. Indeed, biological aggressivity, whether local or at a distance, is a prerogative of both large and small tumours. Therefore a microcarcinoma must be considered a full-blown form of thyroid cancer and as such must be treated. Total thyroidectomy may be followed by identification of possible local metastases. "Whole body" scintigraphy allows to identify and treat with radioiodine therapy, possible recurrent lesions. Therefore in conclusion, total resection is not only a useful, but also a necessary treatment for the correct diagnostic and therapeutic follow-up of these patients

RUGGIERI, MASSIMO

GARGIULO, Patrizia

M. Genderini

A. Del Grammastro

A. Mascaro

B. Luongo

A. Paolini

Archivio della ricerca- Università di Roma La Sapienza

Surgical treatment of differentiated microcarcinomas of the thyroid.

Abstract While the principles of eyelid reconstruction are well-established, achieving good functional and aesthetic reconstruction remains challenging. This communication presents a technique that we used on a young patient with an eyelid defect following a thermal burn. The patient was operated on to reconstruct the entire upper eyelid using, as a posterior lamella, a mucochondrial autologous graft taken from the ala of the nose as a tarsus and conjunctiva substitutes that were sutured to the Elevator palpebrae superioris aponeurosis and muscle. On the other hand, to reconstruct the anterior lamella, which consists of skin and muscle, the surgeons used a myocutaneous temporal flap taken from the region immediately lateral to the external canthus of the palpebral region, and which, after being isolated following a drawing of the upper eyelid to be reconstructed, was rotated and then sutured to the posterior lamella using the orbicularis oculi muscle as a pedicle.</p

Corelli Roberto

Inchingolo Alessio D

Marrelli Massimo

Abenavoli Fabio M

Tatullo Marco

Inchingolo Francesco

Inchingolo Angelo M

Dipalma Gianna

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Head & Face Medicine

Upper eyelid reconstruction: a short report of an eyelid defect following a thermal burn

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DMD: Upper Eyelid Reconstruction. Plastic & Reconstructive Surgery

Reconstruction of the entire upper eyelid area with a subcutaneous pedicle flap based on the orbicularis oculi muscle. Plastic & Reconstructive Surgery

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2787488

Upper eyelid reconstruction: a short report of an eyelid defect following a thermal burn

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Archivio della ricerca- Università di Roma La Sapienza

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