๐ ็ธฝ็ฎ้ ๏ฝ ๐ ่ฑๆๅๆ๏ผๆฌ็ฏ๏ผ ๏ฝ ๐ ๅฎๆด็ฟป่ญฏ ๏ฝ โญ ็ฒพ่ฏ็ญ่จ
FULL-THICKNESS EYELID REPAIRS
FULL-THICKNESS EYELID REPAIRS
Once the full thickness of the eyelid is involved, the reconstructive technique must provide an adequate mucosal surface to replace the missing posterior lamella, as well as the anterior lamella. The conjunctival fornices are generous both medially, and more so laterally, allowing significant central displacement with large wedges that can be reapposed once the lateral canthus and septal attachments are released. For even larger excisions, the tarsal plate and mucosal surface are provided by the release and advance of the upper portion of the inner aspect of the upper eyelid via the supremely versatile Hughes flap. The loss of the medial canthal ligaments and canaliculi, with resultant epiphora, will require a complex multistage reconstruction by oculoplastic and lacrimal surgeons. The primary repair should aim to reconnect the medial edges of the upper and lower lids back together and to draw the reformed medial canthus to the posterior lacrimal crest. The anterior lamella can then be covered with any of the above techniques.
In deciding the best way to reconstruct the tissue lost following tumor extirpation, it is traditional to divide the periocular area involved into subunits and then consider the options for progressively larger defects in that area.