4975 Myocutaneous Upper Eyelid: Bridging the Reconstruction with Aesthetic Satisfaction

Friday, May 6, 2011
Daniel Volpato1, Gustavo Adolfo Almanzar German2, Rodrigo d'Eça Neves, MD3, Jorge Bins Ely, MD, MSc, PhD3, Leonello Ellera Bochese, MD3, Juan Camilo Aleán, MD3, Dimitri Cardoso Dimatos, MD3, Geovani Baptista dos Santos, MD3, Arthur Koerich d'Avila, MD3, Felipe Wohlgemuth, MD4 and Fabrício Ferreira, MD3, (1)Serviço de Cirurgia Plástica, Universidade Federal de Santa Catarina - Brazil, Florianópolis, Brazil, (2)Serviço de Cirurgia Plástica, Universidade Federal de Santa Catarina, Florianópolis, Brazil, (3)Serviço de Cirurgia Plástica (Division of Plastic Surgery), Hospital Universitário - Universidade Federal de Santa Catarina, Florianópolis, Brazil, (4)Serviço de Cirurgia Plástica (Division of Plastic Surgery), Hospital Universitário - Universidade Federal de Santa Catarina, Florianopolis, Brazil
Goals/Purpose: The flap of the upper eyelid (RMPS) was described to correct defects of the lower eyelid, which finds its best applicability. However, in patients requiring reconstruction of lesions near the lid and have a important dermatochalasis, this flap can be used as well to correct the defect, adding a satisfactory result to the patient. The purpose of this study is to demonstrate the versatility of RMPS being a viable alternative in patients with periorbital lesions, including the nasal dorsum, cheek and temporal region.

Methods/Technique: A prospective study in the Department of Plastic Surgery, University Hospital, Federal University of Santa Catarina between April 2008 and July 2009. We included patients who needed reconstruction of acquired defects where reconstruction was possible with this type of flap. To this end, it was necessary to have dermatochalasis eyelid, consent and willingness of patients to be subjected to this technique, and that the defect was created between a consistent distance to the length of the upper eyelid horizontally. The flap used was made with the medial or lateral pedicle according to the defect area, suturing the flap on the base itself in the form of a tunnel. After reconstruction, the patient was asked not to put cold compresses on the pedicle, and underwent surgery in 3 weeks for delivery of the pedicle and refinement of the eyelid. The contra-lateral blepharoplasty was performed in the second surgery. The patient follow-up was at least 3 months with monthly.

Results/Complications: We obtained a sample of four patients who underwent reconstruction with myocutaneous upper eyelid (RMPS). All defects were tumor resections immediate results, which were situated in different locations as the lower eyelid, cheek region, malar, temporal and proximal nasal dorsum. The patients were satisfied with the reconstruction as well as blepharoplasty. Only one of the patients needed only one surgical time. RMPS was described by Leon Tripier in 1889, has since been considered an excellent alternative for reconstruction of small defects of the lower eyelid, by having a thin skin of good quality and an adequate vascularity. Many patients with skin cancer are older compatible with eyelid excess skin. This fact shows us that our patients often present, besides the need to reconstruct, some esthetic complaint which could be used in favor of a technique that yields good results and relative safety by not showing excessive retractions. The flap pedicle presenting a temporal artery branches in the lateral and supra-orbital and supra-trochlear medial entering the orbicularis muscle by the posterior surface forming an interconnected network and making this flap as type 3, Nahai. It may be made either with medial pedicle as a sideline, depending on the area to be reconstructed. Patients who will undergo this procedure should be counseled on the steps of the surgery, as well as involving the aesthetic, which requires understanding of the risks and benefits of surgery beyond informed consent, many times will require a second surgery to release pedicle and refinement of the eyelid. When the defect using the middle portion of the flap, this technique is a good option, but when the distal portion of the flap will be used, is riskier to do it because there will be marooned outside force against the pedicle, and we prefer to do it with external pedicle. The outer pedicle seems to be more reliable but will always require a second procedure, which is not the case with the pedicle islanded you need a single surgical procedure. There is also the possibility of combining the two techniques, as was done in one of our patients. In many cases the RMPS is not the first choice, such as defects in the nasal dorsum or the temporal region. What we observe is that in patients where there was consistency of performing a blepharoplasty, the flap has become an alternative with results that were considered satisfactory by patients and medical staff, in addition to improved periorbital aesthetic. The RMPS is presented as a better option against the skin graft due to the fact that less shrinkage rate of healing with the flap.

Conclusion: The RMPS is a good option in selected patients and can be used to expand the arsenal of the plastic surgeon in periorbital reconstruction.

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