View 2019 Abstracts

TitleA Modified Lateral Periosteal Flap for Reconstruction of Eyelid Defects
Submitted byKatja Ullrich
Abstract Number312
Review Resultposter presentation
Purpose

In reconstruction of the lower eyelid defects, it is essential to achieve good eyelid position with appropriate vectors of the lateral eyelid, to achieve good functional and cosmetic outcomes.

Methods

We describe a technique of using periosteum from the lateral orbital rim to replace the tarsal plate.

The full thickness eyelid defect should be no more than 30%. The periosteal flap can be combined with other techniques if the defect is larger. The lateral orbital rim is exposed with the aid of a lateral canthotomy if needed. The length of the defect is assessed: the periosteal flap should be short enough to put the eyelid on mild traction but long enough to avoid undue tension and possible dehiscence.
Two parallel vertical cuts are made into the periosteum following the lateral orbital rim, approximately 3 mm apart and then joined at one end. For the lower eyelid, the flap should be based superiorly, for the upper eyelid it is best based inferiorly. It can be elevated from the lateral orbital rim using a periosteal elevator or dissected with spring scissors. The edges of the flap are sutured to the remaining tarsal plate with two parallel 5.0 vicryl sutures. The posterior lamella should be in good position and under mild tension. The anterior lamella can be repaired with a local flap or skin graft.

Results

We present 7 patients ranging in age from 61-93 years (mean age 78 years). The periosteal flap was combined with a free tarsal graft in 2 patients and a Hughes flap in 1 patient. At the first postoperative follow-up (approximately 2 weeks) 5 patients (71%) had similar or only slightly different eyelid contour and all 7 patients (100%) had a normal eyelid vector. At the most recent follow-up, all 7 patients had normal or only slightly different eyelid contour and all 7 patients (100%) had a normal eyelid vector. Follow up was 9-18 months. Complications included dehiscence requiring repeat repair (n = 1) and suture allergy (n = 1). Only one patient reported post-operative discomfort.

Conclusion

A modified approach to creating a periosteal flap from the lateral orbital rim can involve less dissection whilst providing similar outcomes to traditional approaches.


Additional Authors

Last nameInitialsCity / HospitalDepartment
LitwinAQueen Victoria Hopsital NHS TrustCorneoplastics Unit