Bratisl Lek Listy. 2024;125(11):666-676. doi: 10.4149/BLL_2024_102.
This prospective study aims to evaluate the demographic and histopathological characteristics of patients who underwent resection of malignant skin tumors of the lower eyelid. It also seeks to assess the size of the defect and outline the management strategies for reconstructing anterior and posterior lamellae.
The study enrolled 87 patients treated between January 1, 2018, and December 31, 2022. The article outlines a reconstructive strategy based on the defect characteristics.
The most prevalent type of tumor was basal cell carcinoma (86%), followed by squamous cell carcinoma (8%), malignant melanoma (5%), and Merkel cell carcinoma (1%). There was a slight male preponderance (52%). No significant difference was found in the incidence of lower eyelid malignant tumor between the sex subgroups (p=0.97). The mean age of the patients was 73.52 years (SD=10.582; range 37-92 years). No statistically significant difference in laterality (p=0.108) was observed. A larger tumor size was significantly associated with a higher tumor grade (p=0.008; r=0.926). A significant correlation was identified between the tumor location and the size of the excision (p<0.001). Furthermore, a significant correlation was identified between the histopathological types of tumors and the excision area (p=0.016). Reconstruction of the anterior lamella in small- and medium-sized defects was achieved by using local randomized flaps (61%), primary closure (29%), and skin grafts (10%). For large-sized defects, the anterior lamella was reconstructed by flap (88%) or skin graft (22%). Altogether, posterior lamella was replaced in 25 cases (29%) of all defects using nasal chondromucosa (40%), conchal cartilage (28%), buccal mucosa (8%), periosteal flap (12%), Hewes flap (8%) and Hughes flap (4%).
Advanced techniques are necessary when reconstructing a larger lower lid area. In such cases, various subunits must be reconstructed separately to achieve optimal functional and aesthetic outcomes. However, the choice of reconstructive technique mainly depends on the extent of the lid resection (Fig. 9, Ref. 44). Text in PDF www.elis.sk Keywords: defects, eyelid, malignant neoplasms, reconstructive surgical procedures, resection.
本前瞻性研究旨在评估接受下眼睑恶性皮肤肿瘤切除术患者的人口统计学和组织病理学特征。还旨在评估缺损的大小，并概述重建前、后睑板的管理策略。
本研究纳入了 2018 年 1 月 1 日至 2022 年 12 月 31 日期间接受治疗的 87 名患者。文章概述了一种基于缺损特征的重建策略。
最常见的肿瘤类型是基底细胞癌（86%），其次是鳞状细胞癌（8%）、恶性黑色素瘤（5%）和 Merkel 细胞癌（1%）。男性略占优势（52%）。不同性别亚组的下眼睑恶性肿瘤发生率无显著差异（p=0.97）。患者的平均年龄为 73.52 岁（标准差=10.582；范围 37-92 岁）。左右侧无统计学差异（p=0.108）。肿瘤越大，肿瘤分级越高（p=0.008；r=0.926）。肿瘤位置与切除面积显著相关（p<0.001）。此外，肿瘤的组织病理学类型与切除面积也显著相关（p=0.016）。小、中缺损的前睑板采用局部随机皮瓣（61%）、一期闭合（29%）和植皮（10%）重建。对于大缺损，采用皮瓣（88%）或植皮（22%）重建前睑板。总的来说，25 例（29%）所有缺损中使用鼻软骨黏膜（40%）、耳软骨（28%）、颊黏膜（8%）、骨膜皮瓣（12%）、Hewes 皮瓣（8%）和 Hughes 皮瓣（4%）替代后睑板。
重建较大的下眼睑区域需要先进的技术。在这种情况下，必须单独重建各个亚单位，以实现最佳的功能和美学效果。然而，重建技术的选择主要取决于眼睑切除的范围（图 9，参考文献 44）。
