PURPOSE: The modified Hughes procedure is used to reconstruct full-thickness lower eyelid defects. A tarsoconjunctival flap from the upper eyelid replaces the posterior lamella, whereas a skin graft, a skin flap, or a skin-muscle flap restores the anterior lamella. The conjunctival pedicle from the upper eyelid is divided after vascularization of the reconstructed lower eyelid is judged to be adequate (traditionally, at least 3 weeks postoperatively). This study reviews the outcomes of patients in whom the conjunctival flap prematurely dehisced. METHODS: Eight patients were identified during a 15-year interval. The posterior lamellar defects ranged in size from 13 to 30 mm horizontally and 5 to 8 mm vertically. The average age at the time of eyelid reconstruction was 72 years (range, 60-84 years). Flap dehiscence, resulting in each case from accidental trauma, occurred between 1 and 11 days postoperatively. Surgical repair of the dehiscence was unsuccessfully attempted in one case; otherwise, the eyelids were permitted to heal spontaneously with the application of erythromycin ophthalmic ointment as the sole therapy. RESULTS: Although the result was satisfactory in each case, one patient, who had dry eyes from Sjögren's syndrome, required secondary surgery to treat mild lagophthalmos and lower eyelid retraction. Follow-up ranged from 3 to 122 months (median, 6.5 months). CONCLUSIONS: The ultimate functional and aesthetic outcomes after premature, traumatic dehiscence of a Hughes flap were surprisingly good, suggesting that elective division of the conjunctival pedicle in routine cases can be performed relatively soon after the primary reconstructive procedure.
PURPOSE: The modified Hughes procedure is used to reconstruct full-thickness lower eyelid defects. A tarsoconjunctival flap from the upper eyelid replaces the posterior lamella, whereas a skin graft, a skin flap, or a skin-muscle flap restores the anterior lamella. The conjunctival pedicle from the upper eyelid is divided after vascularization of the reconstructed lower eyelid is judged to be adequate (traditionally, at least 3 weeks postoperatively). This study reviews the outcomes of patients in whom the conjunctival flap prematurely dehisced. METHODS: Eight patients were identified during a 15-year interval. The posterior lamellar defects ranged in size from 13 to 30 mm horizontally and 5 to 8 mm vertically. The average age at the time of eyelid reconstruction was 72 years (range, 60-84 years). Flap dehiscence, resulting in each case from accidental trauma, occurred between 1 and 11 days postoperatively. Surgical repair of the dehiscence was unsuccessfully attempted in one case; otherwise, the eyelids were permitted to heal spontaneously with the application of erythromycin ophthalmic ointment as the sole therapy. RESULTS: Although the result was satisfactory in each case, one patient, who had dry eyes from Sjögren's syndrome, required secondary surgery to treat mild lagophthalmos and lower eyelid retraction. Follow-up ranged from 3 to 122 months (median, 6.5 months). CONCLUSIONS: The ultimate functional and aesthetic outcomes after premature, traumatic dehiscence of a Hughes flap were surprisingly good, suggesting that elective division of the conjunctival pedicle in routine cases can be performed relatively soon after the primary reconstructive procedure.
Authors: Ahmed M Hishmi; Konrad R Koch; Mario Matthaei; Edwin Bölke; Claus Cursiefen; Ludwig M Heindl Journal: Eur J Med Res Date: 2016-06-30 Impact factor: 2.175