Grafts and Local Flaps in Head and Neck Cancer
John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford in Head & Neck Surgery Plastic Surgery, 2018
The majority of defects of the cheek will be following ablative surgery for cutaneous malignancies. These normally present in the elderly population and even quite large defects can be closed directly, due to pre-existing skin laxity in this age group. As well as the relaxed skin tension lines, there are other noticeable lines in the cheek in which scars can be hidden. These are the nasolabial fold, infraorbital rim, alar crease, hairline and jawline. Split-thickness skin grafts on the cheek are very noticeable as they tend to transgress the different regions of the cheek and alter the contour and colour, giving a poor cosmetic result. When used in close proximity to the lower eyelid, they may also result in ectropion. For situations where a skin graft is necessary, full-thickness grafts are best to limit contracture and improve colour match. For small defects not amenable to direct closure, local flaps are appropriate. Due to the large surface area of the cheek, a full range of flaps can be utilized, including rhomboid transposition flaps, small cheek rotation–advancement flaps (Figure 91.19) or V–Y advancement flaps. Defects that are not amenable to small local flaps may require reconstruction with a cervicofacial flap (Figure 91.20).65 These flaps import tissue from the neck and lower jawline, giving excellent colour, texture and contour match.
Orbital Fractures
Jeffrey R. Marcus, Detlev Erdmann, Eduardo D. Rodriguez in Essentials of CRANIOMAXILLOFACIAL TRAUMA, 2014
The subciliary approach was first described for use in orbital trauma by Converse in 1944. It was described as an incision several millimeters below the lash line. There are two main variations of this approach: the skin-only flap approach and the skin-muscle flap approach. The skin-only flap approach involves dissection just below the skin and superficial to the orbicularis oculi muscle to the level of the infraorbital rim. It has been associated with skin necrosis and a high rate of ectropion. The stepped technique is a variation in which the skin flap is elevated for 4 to 5 mm before splitting the muscle along its fibers, then continuing in the preseptal (submuscular) plane. It is said to be associated with less scar inversion and a lower incidence of ectropion. By dissecting inferiorly for several millimeters, it avoids the pretarsal portion of the orbicularis oculi, which provides lower lid support. Loss of pretarsal orbicularis activity predisposes to ectropion. In comparison, the skin-muscle flap approach divides the skin and the orbicularis oculi muscle at the same level, with the dissection then proceeding in the preseptal plane deep to the orbicularis oculi to the level of the infraorbital rim.
Medical Negligence in Otorhinolaryngology
John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie in Basic Sciences Endocrine Surgery Rhinology, 2018
Great care must be taken over the amount of skin that is excised. Lagophthalmos, incomplete upper eyelid closure, is a normal occurrence in the first 48 hours after surgery. It usually resolves spontaneously but a large lagophthalmos (greater than approximately 3 mm), or if it persists, indicates overexcision of upper eyelid skin. If left untreated, dry eye symptoms and corneal exposure occur. The best treatment is replacement of the excised skin, providing that this has been stored in a refrigerator at the time of the operation, as this provides the best match. Ectropion is often due to excessive removal of skin but may be due to other causes such as scar contracture or a lax lid margin. Taping of the lower lid, and if necessary a support stitch, for a few weeks may resolve the problem but permanent ectropion will require skin grafting that will leave additional scars.
“The influence of orbital vector on involutional entropion and ectropion”
Published in Orbit, 2018
Mohammad Taher Rajabi, Farshad Gholipour, Koosha Ramezani, Seyedeh Simindokht Hosseini, Mohammad Bagher Rajabi, Seyed Ziaeddin Tabatabaie
Out turning of the eyelid margin, known as ectropion, and in turning of the eyelid margin, known as entropion, are common age-related disorders of the eyelid.6 They can be either congenital or acquired. The acquired forms include acute spastic, cicatricial and involutional entropion, as well as cicatricial, involutional, mechanical, and paralytic ectropion. The involutional malposition is the most common form.7,8 The prevalence of involutional eyelid malpositions is 2.1% for entropion (1.9% in men and 2.4% in women) and 2.9% for ectropion (5.1% in men and 1.5% in women) in people older than 60 years. The white population is more affected by involutional entropion and ectropion than blacks. Gender differences exist due to the difference in tarsal plate size and axial ocular globe projection, which leads to more frequent involutional ectropion involvement in men and more cases of involutional entropion in women.2,9,10
Ocular Surface Disease and Anti-Glaucoma Medications: Various features, Diagnosis, and Management Guidelines
Published in Seminars in Ophthalmology, 2023
Sowmya Andole, Sirisha Senthil
Topical beta-blockers can cause medication-induced adverse effects on the eyelids and conjunctiva. Apraclonidine can cause contact dermatitis of the periocular area and eyelids.7 Contact dermatitis occurs due to a portion of the drug binds to the dermal protein to form a complex hapten, which sensitizes the individual. When the drug is re-instilled it induces a delayed hypersensitivity reaction, which is the cause for allergy. Apraclonidine can also cause ectropion of the eyelid which progressed to cicatricial ectropion in some patients.20,21 In individuals with preexisting lid laxity, tissue edema due to allergy can worsen the preexisting problem resulting in ectropion. Chronic allergy with skin excoriation can also cause fibrotic changes and tissue shortening that can lead to ectropion.
Complications and posttreatment care following invasive laser skin resurfacing: A review
Published in Journal of Cosmetic and Laser Therapy, 2018
Dan Li, Shi-Bin Lin, Biao Cheng
Scarring, a rare but perhaps the most worrisome complication, is mainly related to excessive treatment energy. Typically, patients with scarring tendencies are screened before treatment. However, when the depth of the LSR reaches below the reticular dermis or the base of the sebaceous glands, it is likely to cause scar tissue production. Prolonged erythema, delayed healing and serious infection in the early stage are signs that may herald scarring. Thus, adequate and timely post-laser care in the early stage may perhaps prevent some of the scar formation induced by infection or delayed wound healing. Notwithstanding these precautions, some scars will inevitably occur. Such scarring may be resolved by serial local injections of triamcinolone accompanied by close observation. Should the scarring be resistant to steroid injections, Mepitel and similar products used in the first healing stage should continue to be applied at this stage, which may help to improve the scar appearance(88). Cicatricial ectropion may be caused by lower eyelid scarring, which may be avoided by the appropriate pretreatment assessment of skin elasticity and by choosing conservative parameters. Once evident, related expectant ophthalmologic treatment must be applied to correct the excessive tearing, dryness, and photophobia caused by the cicatricial ectropion-caused exposure of the conjunctiva. Whereas mild ectropion of the lower lids is usually reversible, severe cases require surgery, such as skin grafting for resolution(89).
Related Knowledge Centers
- Conjunctivitis
- Cornea
- Eyelid
- Surgery
- Harlequin-Type Ichthyosis
- Facial Nerve Paralysis
- Injury
- Cervical Ectropion
- Entropion