Shope Chelsea, Gonzalez-Parrilla Leonardo, Atherton Kelly, Eiseman Andrew, Patel Krishna
From the College of Medicine.
Department of Otolaryngology-Head and Neck Surgery.
Ann Plast Surg. 2023 Dec 1;91(6):726-730. doi: 10.1097/SAP.0000000000003669. Epub 2023 Sep 4.
Malignant cutaneous eyelid tumors account for approximately 10% of all cutaneous cancers. Like other cancerous skin lesions, treatment commonly involves excision with wide margins, requiring tissue reconstruction. The use of the paramedian forehead flap (PMFF) has been described for reconstruction of the medial and upper eyelid, but literature is lacking for its use in lower eyelid anterior lamella reconstruction. We present a case series of patients who underwent reconstruction of lower eyelid defects using the PMFF.
We present 2 patients who underwent reconstruction of lower eyelid defects using the PMFF surgical technique. The patients had previous history of lower lid repair with other reconstructive methods because of cancerous eyelid lesions. In addition, both received adjuvant radiation therapy, which led to development of ectropion. Postoperative signs, symptoms, and photographs were collected to monitor outcomes.
Reconstructions were performed by the collaborative efforts of a facial plastic reconstructive surgeon and oculoplastic surgeon using a staged PMFF approach. Postoperatively, both patients had significant improvement in ophthalmologic symptoms, particularly ectropion and lagophthalmos. At their most recent follow-up visit, they were satisfied with their functional and aesthetic outcomes.
The PMFF may be safely used to reconstruct defects of the lower eyelid anterior lamella. In this study, the PMFF has proven to be an excellent option for patients with complications after previous lower eyelid reconstructions or history of radiation therapy. Overall, the PMFF should be considered as part of the surgeon's reconstructive ladder when addressing lower eyelid defects.
恶性眼睑皮肤肿瘤约占所有皮肤癌的10%。与其他皮肤癌性病变一样，治疗通常包括广泛切除边缘组织，这需要进行组织重建。正中旁前额皮瓣（PMFF）已被用于内侧和上眼睑的重建，但缺乏其用于下眼睑前层重建的相关文献。我们报告一系列使用PMFF进行下眼睑缺损重建的病例。
我们报告2例使用PMFF手术技术进行下眼睑缺损重建的患者。由于眼睑癌性病变，这2例患者既往曾采用其他重建方法修复下眼睑。此外，2例患者均接受了辅助放疗，导致睑外翻。收集术后体征、症状及照片以监测治疗效果。
由面部整形重建外科医生和眼整形医生共同协作，采用分期PMFF方法进行重建。术后，2例患者的眼科症状均有显著改善，尤其是睑外翻和兔眼症。在最近一次随访时，他们对功能和美学效果均感到满意。
PMFF可安全用于重建下眼睑前层缺损。在本研究中，PMFF已被证明是既往下眼睑重建术后出现并发症或有放疗史患者的理想选择。总体而言，在处理下眼睑缺损时，PMFF应被视为外科医生重建方法中的一部分。
