Офтальмохирургия (Dec 2017)
OPTIMIZATION OF A RECONSTRUCTIVE PLASTIC SURGERY OF EXTENSIVE CICATRICAL BLEPHARON DEFECTS WITH MULTIPARTITE TISSUE COMPLEX
Abstract
Purpose. Assessment of efficiency in the use of a multi-component tissue complex for an optimization of reconstructive plastic surgery for extensive cicatrical deformations of blepharons.Material and methods. The analysis of plastic reconstruction of extensive cicatrical defects of blepharons was carried out in 30 patients (30 eyes) aged from 27 to 68 years (average: 52.9±14 years). The reasons of cicatrical deformations of blepharons were: mechanical traumas – 9 patients, gunshot injuries and explosive traumas – 4, tumor surgeries – 12, stings of animals – 5. The area of the eyelid defect was from 69 to 105 mm2(average: 87.5±9.0 mm2).All patients were divided into 2 groups. The main group included 15 patients (15 eyes) who underwent the operation with the technique of layerby-layer reconstruction of the eyelid using a three-layer multicomponent tissue complex consisting of a mucoperiosteal flap, a muscle-fascial flap of the temporal muscle, free skin graft. The comparative group was composed of 15 patients (15 eyes) where a two-layer graft was used which consisted of a mucoperiosteal flap and a skin flap on the nourishing base to recover the penetrating extensive eyelid defect.Results and discussion. On the 5th day after the operation, signs of infection and hematoma of the eyelids were absent, and there was a moderate edema of tissues in all patients of the main and comparative groups.On the 10th day after the operation, the skin graft acquired a pink tint on its entire surface in patients of the main group. In the comparative group, the pink shade of the skin graft was noted only from the side of the nourishing pedicle, the rest part kept a pale shade and areas of epidermal necrosis.After 1 month, the reparative process culminated in the formation of a tender fine scar, and the mobility of the eyelids appeared in the patients of the main group. The size of palpebral fissure varied from 9 to 11mm (on average 10.1±0.5mm), the deviation of the palpebral fissure size was about «-»16%. In the comparative group, the reparative process was completed by the formation of a tender fine scar only in 5 patients. In 10 patients a reduction of the graft and a formation of scar tissue retraction were observed, with a deviation in the size of the palpebral fissure by 8-12mm (on average 10.9±1.0) compared with the healthy one. Visible scar deformations of the eyelids were not observed 3 months after the operation in patients of the main group. The deviation of the palpebral fissure size was «-»7-8%. In the comparative group a cicatricial shortening of the operated eyelid with the formation of coloboma and ectropion occurred in 3 patients.During 2 years of follow-up, the correct position and anatomy of the eyelids remained in the patients of the main group, the size of the palpebral fissure averaged to 11.7±0.5mm and did not differ significantly from the healthy eye (11.9±0.4mm), p>0.05.Within the same period in the comparison group 5 patients had an incorrect position of the operated eyelid (retraction, ectropion, entropion), which required repeated plastic reconstructions.Indices of hemodynamics: in the main group, the complete correspondence of parameters of blood flow to the tissues of the healthy eyelid occurred 1 month after the operation (p>0.05). In the comparative group positive changes were detected only 3 months after blepharoplasty. In the comparative group positive changes were detected only 3 months after blepharoplasty.Conclusions. The proposed combined method of blepharoplasty for extensive complicated cicatrical defects allows to reduce its multistage approach, to increase donor resources in order to receive the desired plastic material, to empower ophthalmoplasty without serious postoperative complications, to improve esthetic results of rehabilitation. Key words: blepharoplasty, extensive cicatrical defects of blepharons,
Keywords
