One-Stage Alternatives to the Hughes Procedure for Reconstruction of Large Lower Eyelid Defects: Surgical Techniques and Outcomes. Issue 2 (March 2016)

• Record Type: Journal Article
• Authors: Skippen, Brent; Hamilton, Alex; Evans, Sam; Benger, Ross
• Is Part Of: Ophthalmic plastic and reconstructive surgery. Volume 32:Issue 2(2016:Mar./Apr.)
• Publication Date: 2016-03
• Subjects: Eye -- Surgery -- Periodicals; Ophthalmic plastic surgery -- Periodicals; Reconstructive Surgical Procedures -- Periodicals; Ophthalmologic Surgical Procedures -- Periodicals; Ophthalmology -- Periodicals; Surgery -- Periodicals; 617.70592
• DOI: 10.1097/IOP.0000000000000622
• Languages: English
• ISSNs: 0740-9303

Abstract

Abstract : Purpose: To present the results of 1-stage surgical advancement flaps for the repair of large full thickness lower eyelid defects. These avoid the disadvantages of the 2-stage Hughes procedure and provide favorable functional and aesthetic outcomes. Methods: A retrospective case series of 36 lower eyelid repairs performed on 31 patients by a single surgeon in Sydney, Australia is presented. The selection criterion was a horizontal defect size 10 mm or greater that could have "classically" been repaired with a 2-stage Hughes procedure. Three different 1-stage surgical repair techniques were utilized, all incorporating local advancement-type flaps: 1) a lateral-based full thickness advancement flap; 2) a vertical tarsal plate advancement flap combined with a full thickness skin graft; and 3) a vertical skin advancement flap combined with a mucosal graft. The postoperative outcomes evaluated included flap viability, lower eyelid margin position and contour, characteristics of the new eyelid margin and patient satisfaction. Results: Thirty-six lower eyelid repairs were performed in 31 patients. There were no cases of flap ischemia, necrosis, or failure. There was 1 case (3%) of postoperative eyelid retraction, 1 case (3%) of eyelid entropion requiring surgical repair, 1 case (3%) of pyogenic granuloma, 2 cases (6%) of eyelid margin cyst, and 7 cases (19%) of eyelid distichiasis. In 34 cases (94%), the patient was satisfied with the aesthetic result. Conclusion: The techniques described provide successful alternatives to the Hughes procedure. They are 1-stage and do not render the patient temporarily monocular, or alter the upper eyelid anatomy or function. All maintained favorable long-term functional and aesthetic outcomes for the reconstructed lower eyelid. Abstract : This case series demonstrates that using local flaps for the reconstruction of large horizontal lower eyelid defects provide successful alternatives to the two-stage Hughes procedure.