Ocular Adnexal Reconstruction for Cutaneous Periocular Malignancies

Abstract

Although the majority of lesions present in the periocular region are benign, periocular cutaneous malignancies are certainly not uncommon and must be considered. The management of nonmelanoma cutaneous malignancies is predominately surgical with Mohs micrographic surgery or excision with frozen sections. The approach to reconstruction of the resulting defects depends on the defect location and size. When able, it is preferable to close lesions directly or with the recruitment of adjacent tissue in an effort to preserve the inherent anatomy. The eyelid's dynamic function is thus maintained, which is essential for optimal ocular surface protection. However, larger and more extensive defects will require complex reconstructions that are able to restore the necessary structural integrity to the eyelids. The authors review the various reconstruction approaches for defects of all sizes involving the periocular area including nonmarginal defects and defects of the lower and upper eyelids, as well as those of the medial canthal region.

Keywords

periocular reconstruction - periocular cutaneous malignancies - eyelid reconstruction - medial canthal reconstruction

• References

• 1 Slutsky JB, Jones EC. Periocular cutaneous malignancies: a review of the literature. Dermatol Surg 2012; 38 (4) 552-569
• 2 Nguyen TH, Ho DQ. Nonmelanoma skin cancer. Curr Treat Options Oncol 2002; 3 (3) 193-203
• 3 Mohs FE. Micrographic surgery for the microscopically controlled excision of eyelid cancers. Arch Ophthalmol 1986; 104 (6) 901-909
• 4 Kroll DM. Management and reconstruction of periocular malignancies. Facial Plast Surg 2007; 23 (3) 181-189
• 5 Hamada S, Kersey T, Thaller VT. Eyelid basal cell carcinoma: non-Mohs excision, repair, and outcome. Br J Ophthalmol 2005; 89 (8) 992-994
• 6 Patrinely JR, Marines HM, Anderson RL. Skin flaps in periorbital reconstruction. Surv Ophthalmol 1987; 31 (4) 249-261
• 7 Hom DM, Tope WD, Murakami CS. Minimally invasive options and principles for cutaneous reconstruction. In: Papel ID, Frodel JL, Holt GR, , et al, eds. Facial Plastic and Reconstructive Surgery. 4th ed. New York, NY: Thieme; 2016: 162-210
• 8 Dutton JJ. Atlas of Oculoplastic and Orbital Surgery. 1st ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2013
• 9 Hudson DA. Some thoughts on choosing a Z-plasty: the Z made simple. Plast Reconstr Surg 2000; 106 (3) 665-671
• 10 Perry JD, Taban M. Superiorly based bilobed flap for inferior medial canthal and nasojugal fold defect reconstruction. Ophthal Plast Reconstr Surg 2009; 25 (4) 276-279
• 11 Iida N, Ohsumi N, Tonegawa M, Tsutsumi K. Simple method of designing a bilobed flap. Plast Reconstr Surg 1999; 104 (2) 495-499
• 12 Esser JFS. Gestiette iokale nasenplastik mit zweizipfligem lappen, deckung des sekundaren defektes vom ersten zipfel durch den zweiten. Langenbeck's Archies of Surgery 1918; 143 (3) 385-390
• 13 Espinoza GM, Prost AM. Upper eyelid reconstruction. Facial Plast Surg Clin North Am 2016; 24 (2) 173-182
• 14 Sand JP, Zhu BZ, Desai SC. Surgical anatomy of the eyelids. Facial Plast Surg Clin North Am 2016; 24 (2) 89-95
• 15 Leibovitch I, Huilgol SC, Hsuan JD, Selva D. Incidence of host site complications in periocular full thickness skin grafts. Br J Ophthalmol 2005; 89 (2) 219-222
• 16 Baylis HI, Perman KI, Fett DR, Sutcliffe RT. Autogenous auricular cartilage grafting for lower eyelid retraction. Ophthal Plast Reconstr Surg 1985; 1 (1) 23-27
• 17 Leibovitch I, Malhotra R, Selva D. Hard palate and free tarsal grafts as posterior lamella substitutes in upper lid surgery. Ophthalmology 2006; 113 (3) 489-496
• 18 Codner MA, McCord CD, Mejia JD, Lalonde D. Upper and lower eyelid reconstruction. Plast Reconstr Surg 2010; 126 (5) 231e-245e
• 19 Mustardé JC. Reconstruction of eyelids. Ann Plast Surg 1983; 11 (2) 149-169
• 20 Bickle K, Bennett RG. Tripier flap for medial lower eyelid reconstruction. Dermatol Surg 2008; 34 (11) 1545-1548
• 21 Wilcsek G, Leatherbarrow B, Halliwell M, Francis I. The ‘RITE’ use of the Fricke flap in periorbital reconstruction. Eye (Lond) 2005; 19 (8) 854-860
• 22 Holds JB. Lower eyelid reconstruction. Facial Plast Surg Clin North Am 2016; 24 (2) 183-191
• 23 Rohrich RJ, Zbar RIS. The evolution of the Hughes tarsoconjunctival flap for the lower eyelid reconstruction. Plast Reconstr Surg 1999; 104 (2) 518-522 , quiz 523, discussion 524–526
• 24 Gassner HG, Sherris DA, Otley CC. Treatment of facial wounds with botulinum toxin A improves cosmetic outcome in primates. Plast Reconstr Surg 2000; 105 (6) 1948-1953 , discussion 1954–1955
• 25 Sherris DA, Gassner HG. Botulinum toxin to minimize facial scarring. Facial Plast Surg 2002; 18 (1) 35-39
• 26 Chen MA, Davidson TM. Scar management: prevention and treatment strategies. Curr Opin Otolaryngol Head Neck Surg 2005; 13 (4) 242-247
• 27 Atiyeh BS, Amm CA, El Musa KA. Improved scar quality following primary and secondary healing of cutaneous wounds. Aesthetic Plast Surg 2003; 27 (5) 411-417