Voigt Sebastian, Broer Peter Niclas, Lorenz Sarah, Ninkovic Milomir, von Spiegel Felix
From the Departments of Plastic-, Reconstructive-, Hand-, and Burn-Surgery, Klinikum Bogenhausen Academic Teaching Hospital, Technical University Munich, Munich, Germany.
J Craniofac Surg. 2015 Jan;26(1):e8-10. doi: 10.1097/SCS.0000000000001218.
Although silicone injections for permanent soft tissue augmentation were popular in the past, their use has become unduly controversial because of severe complications, mainly caused by injection of illegal silicones by unlicensed practitioners. The delicate local anatomy of the lower eyelid region makes this region particularly susceptible for complications after silicone augmentation including local inflammation, tissue retraction, and consecutive cicatricial ectropion leading to lagophthalmus and ocular surface irritation.
This is a case of a 47-year-old patient demonstrating severe lower eyelid destruction with consecutive ectropion after injection of commercial grade silicone in Thailand 5 years prior, leading to chronic granulomatous infections requiring multiple surgical interventions.Our hybrid approach included radical debridement with complete elimination of silicone residues, lateral canthopexy, reconstruction of the entire lower eyelid esthetic unit using a supraclavicular full-thickness skin graft, and temporary tarsorrhaphy followed by 2 sessions of autologous fat graft injections.Although many previous publications mainly focus on individual aspects of lower eyelid reconstruction, we describe a staged reconstructive approach for correction of severely destructed lower eyelid defects with consecutive lower eyelid ectropion.
The hybrid approach presented here has proven to be a viable surgical strategy for lower eyelid reconstruction, with esthetically appealing results.
尽管过去用于永久性软组织填充的硅胶注射很流行，但由于严重并发症，其使用已引发过度争议，这些并发症主要由无执照从业者注射非法硅胶所致。下眼睑区域精细的局部解剖结构使得该区域在硅胶填充后特别容易出现并发症，包括局部炎症、组织回缩以及连续性瘢痕性睑外翻，进而导致兔眼和眼表刺激。
这是一例47岁患者的病例，该患者5年前在泰国注射商业级硅胶后出现严重的下眼睑破坏及连续性睑外翻，导致慢性肉芽肿感染，需要多次手术干预。我们的综合方法包括彻底清创以完全清除硅胶残留、外眦固定术、使用锁骨上全厚皮片重建整个下眼睑美学单元、临时睑缘缝合，随后进行2次自体脂肪移植注射。尽管之前许多出版物主要关注下眼睑重建的个别方面，但我们描述了一种分阶段重建方法，用于矫正严重破坏的下眼睑缺损及连续性下眼睑睑外翻。
本文提出的综合方法已被证明是一种可行的下眼睑重建手术策略，具有美观的效果。
