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EYELID RECONSTRUCTION AN OVERVIEW EYELID RECONSTRUCTION AIMS MAINTAIN FUNCTION & INTEGRITY OF PERIORBITAL STRUCTURES ACHIEVE OPTIMAL COSMESIS EYELID RECONSTRUCTION GOALS SMOOTH MUCOSA-LIKE INTERNAL LINING STABLE EYELID MARGIN WITH LASHES PROJECTING AWAY FROM THE GLOBE LID RIGIDITY OF THE TARSAL AND CANTHAL AREAS FUNCTIONAL RETRACTORS ADEQUATE CLOSURE FOR PROTECTION AND LUBRICATION ACCEPTABLE COSMESIS EYELID RECONSTRUCTION –ANATOMY EYELID POSITION HALFWAY BETWEEN PUPIL & LIMBUS – NORMAL EXCURSION 16MM CANTHAL POSITION - LATERAL AGAINST GLOBE MEDIAL, SEPARATION BY LACRIMAL CARUNCLE EYELID ANATOMY LATERAL ANGLE 2-3MM HIGHER THAN THE MEDIAL CANTHAL AREA EYELIDS TWO LAMELLA ANTERIOR - SKIN AND MUSCLE, POSTERIOR - CONJUNCTIVA TARSAL PLATE LID RETRACTORS EYELID ANATOMY LID MARGIN 2MM THICK ANTERIOR EYELASHES POSTERIOR MEIBOMIAN GLAND ORIFICES GREY LINE SEPERATES TWO AREAS EYELID ANATOMY PUNCTUM INFERIOR TYPICALLY 2MM LATERAL TO SUPERIOR BLOOD SUPPLY MARGINAL ARTERY 3-4MM FROM MARGIN LACRIMAL SYSTEM LACRIMAL GLAND LACRIMAL DRAINAGE SYSTEM PUNCTA UPPER AND LOWER CANALICULI LACRIMAL SAC AND NASO-LACRIMAL DUCT PREPARATION GLOBE PROTECTION LUBRICATION CORNEAL PROTECTOR SUTURE PLACEMENT ANAESTHESIA – LOCAL, GENERAL, TOPICAL WOUND PREPARATION – MINIMAL DEBRIDEMENT DEFECTS UPPER LOWER DO NOT USE UPPER LID FOR LOWER LID DEFECTS LOWER LID DEFECTS PARTIAL FULL THICKNESS LOWER LID DEFECTS PARTIAL – PRIMARY CLOSURE FLAPS FULL THICKNESS GRAFT Direct Closure PRIMARY CLOSURE VERTICAL NOT HORIZONTAL PENTAGONAL= NO NOTCH FULLTHICKNESS GRAFT UPPER LID EXCESS SKIN POST AURICULAR ? 2 SSG PRE AURICULAR THICKER & LIMITED SUPRACLAVICULAR THICKER, COLOUR MATCH NOT AS GOOD FLAPS VY FROM CHEEK TRANSPOSITION GLABELLA, NASOLABIAL, EYELID OR BROW ROTATION ADVANCEMENT CHEEK LOWER LID DEFECTS FULL THICKNESS EXTENSILE APPROACH ¼ TO 1/3 – COMPOSITE GRAFT FROM OPPOSITE LID, UP TO 50%. – LATERAL CANTHOTOMY GREATER THAN 50% – CHEEK ROTATION OR VY FLAP AND MUCOCHONDRAL GRAFT LOWER LID DEFECTS FULL THICKNESS EXTENSILE APPROACH LOWER LID DEFECTS FULL THICKNESS EXTENSILE APPROACH LOWER LID DEFECTS FULL THICKNESS EXTENSILE APPROACH LOWER LID DEFECTS FULL THICKNESS EXTENSILE APPROACH LOWER LID DEFECTS FULL THICKNESS EXTENSILE APPROACH LOWER LID DEFECTS FULL THICKNESS NB ? NEED FOR MUCOUS LINING IN LOWER LID DEFECTS. SOURCE OF CHONDRO- MUCOSAL GRAFT UPPER LID DEFECTS - PARTIAL THICKNESS - DIRECT CLOSURE - LOCAL FLAP - FTG FROM OTHER LID - DISTANT FLAP TEMPLE FLAP UPPER LID DEFECTS - FULL THICKNESS - SIMILAR CONSIDERATIONS TO LOWER EYELID. UPPER LID DEFECTS - - FULL THICKNESS SIMILAR CONSIDERATIONS TO LOWER EYELID. UPPER LID DEFECTS - - FULL THICKNESS SIMILAR CONSIDERATIONS TO LOWER EYELID. UPPER LID DEFECTS - - FULL THICKNESS SIMILAR CONSIDERATIONS TO LOWER EYELID.
