| Abstract: |
Eyelids are complex structures and pose a challenge for reconstruction. They play an important role in protecting the globe from trauma, excessive light, and in maintaining the integrity of tear film and moving the tears toward the lacrimal drainage system. The beauty and expression to the eye is given by the lids and muscles in it The eyelid consists of the anterior and the posterior lamellae. During reconstruction, both must be repaired to achieve optimal eyelid function, globe protection, and cosmesis. The method of reconstruction is dependent on the overall size of the wound, the state of the eyelid margin, age of the patient, the availability and elasticity of surrounding tissues, and the surgeon’s experience and preferences. Regardless of which method is chosen, there must be an inherent blood supply for either the anterior or the posterior lamella, only one layer can consist of a graft; the other must be composed of a vascularized flap.Partial thickness (anterior lamellar) defects are reconstructed by: [1] primary closure, [2] local skin and myocutaneous flap, [3] full thickness skin graft, and [4] Secondry intention healing Full-thickness defects are reconstructed (according to the site and size of the defect) by: (1) Defects 25% of lid margin are repaired by primary closure,(2) Defects 25–50% of lid margin are repaired by primary closure + lateral canthotomy & cantholysis, (3) Defects of 50–75% of lid margin are repaired by Tenzel semicircular flap, (4) Upper eyelid defects 75% of lid margin are repaired by Cutler-Beard technique, (5) Lower eyelid defects 75% of lid margin are repaired by Hughes tarsoconjunctival flap + full thickness skin graft or local flap, (6) Also, large lower lid defects 75% can be repaired by Mustardé rotational cheek flap with posterior lamella graft, (7) Defects 75% of lid margin (UL or LL) are also repaired by free graft for posterior lamella + local flap for anterior lamella, (8) Defects 8 mm of lid margin may be repaired by composite lid grafts, and (9) Healing by second intention. Medial canthus defects are reconstructed by: [1] secondry intention, [2] local flaps (e.g. glabellar transposition flap), [3] paramedian forehead flap, [4] full-thickness skin grafts and [5] combination of above The aim of this work is to compare the functional, cosmetic outcome and patient satisfaction following eyelid reconstruction using different techniques for repair of full thickness defects after trauma or tumor excision.This study was carried out on forty eyelids (40) of forty patients - who needed eyelid reconstruction following eyelid tumors excision, trauma or congenital coloboma. They were classified into three groups according to the site of the lesion: Group (A): This group included 10 upper eyelid lesions. Group (B): This group included 26 lower eyelid lesions. Group (C): This group included 4 cases of medial canthal lesionGroup (A) and Group (B) were subdivided into 3 subgroups according to the size of the defect The range of age for all cases extended from one month of age to 82 years old, while in lid mass patients age distributed from 40 to 80 years old with average of 58.4 years. The peak incidence of age distribution was between 52 and 65 years [22 cases (55 %)]. There was no marked sex difference in our study. In our study we defined the main three causes for lid defects; trauma, congenital coloboma and after tumor resection. The highest incidence was.
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