From the Division of Plastic and Reconstructive Surgery, Northwestern Memorial Hospital.
Plast Reconstr Surg. 2019 Aug;144(2):443-455. doi: 10.1097/PRS.0000000000005882.
Lower eyelid defects are traditionally classified based on depth and 25 percent increments in defect width. The authors propose a new classification system that includes the vertical defect component to predict functional and aesthetic outcomes.
A retrospective review of patients who underwent lower lid reconstruction performed by a single surgeon was performed. Defects were classified into four categories based on the vertical component: (1) pretarsal; (2) preseptal; (3) eyelid-cheek junction; and (4) complex pretarsal/preseptal. Preoperative and postoperative central and lateral marginal reflex distance-2 values were obtained. Aesthetic outcomes were evaluated by three blinded reviewers. Outcomes were compared using one-way analysis of variance and analysis of covariance with Bonferroni corrected post hoc comparisons to control for defect area and width.
Thirty-four patients underwent reconstruction of lower eyelid defects. There were 12 pretarsal defects (type I), nine preseptal defects (type II), nine eyelid-cheek defects (type III), and four complex pretarsal/preseptal defects (type IV). Postoperative retraction was highest in the complex pretarsal/preseptal group at 75 percent, with a significantly greater change from preoperative to postoperative central and lateral marginal reflex distance-2 compared with the other groups (p < 0.01) and worse postoperative mean aesthetic scores (p < 0.001). Type IV patients had significantly more revision operations (mean, 5.5) compared with the other groups (p < 0.001).
The vertical dimension of lower eyelid defects is an important variable. A new classification system is proposed that supplements width-based methods for improved surgical planning and prediction of postoperative outcomes in lower eyelid reconstruction.
CLINICAL QUESTION/LEEVL OF EVIDENCE: Therapeutic, IV.
传统上，下眼睑缺损根据深度和缺损宽度的 25%增量进行分类。作者提出了一种新的分类系统，该系统包括垂直缺损成分，以预测功能和美学效果。
对一位外科医生进行的下眼睑重建的患者进行了回顾性研究。根据垂直成分将缺陷分为四类：（1）睑板前；（2）睑板前；（3）睑颊结合部；（4）复杂的睑板前/睑板前。获得了术前和术后中央和外侧边缘反射距离-2 值。由三位盲审员评估美学效果。使用单向方差分析和协方差分析进行比较，并使用 Bonferroni 校正的事后比较来控制缺陷面积和宽度。
34 例患者行下眼睑缺损重建术。有 12 例睑板前缺损（I 型），9 例睑板前缺损（II 型），9 例睑颊部缺损（III 型）和 4 例复杂的睑板前/睑板前缺损（IV 型）。复杂的睑板前/睑板前组的术后回缩率最高为 75%，与其他组相比，中央和外侧边缘反射距离-2 的术前到术后变化显著更大（p<0.01），术后平均美学评分更差（p<0.001）。与其他组相比，IV 型患者的修复手术明显更多（平均 5.5 次）（p<0.001）。
下眼睑缺损的垂直维度是一个重要的变量。提出了一种新的分类系统，该系统补充了基于宽度的方法，以改善下眼睑重建的手术规划和预测术后结果。
临床问题/证据水平：治疗，IV 级。
