University of California Los Angeles Division of Plastic & Reconstructive Surgery Reconstruction of...
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University of California Los Angeles Division of Plastic & Reconstructive Surgery Reconstruction of the Severely Scarred and Displaced Lower Eyelid Following Violation of All Three Lamellar Planes Jason Roostaeian, MD, Emil Kohan, MD, Neil Tanna, MD, Henry K. Kawamoto MD, DDS, James P. Bradley, MD Mattel Children’s Hospital UCLA Ronald Reagan Medical Center
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Transcript of University of California Los Angeles Division of Plastic & Reconstructive Surgery Reconstruction of...
University of California Los AngelesDivision of Plastic & Reconstructive Surgery
Reconstruction of the Severely Scarred and Displaced Lower Eyelid Following Violation of All Three Lamellar Planes
Jason Roostaeian, MD, Emil Kohan, MD, Neil Tanna, MD, Henry K. Kawamoto MD, DDS, James P. Bradley, MD
Mattel Children’s HospitalUCLA Ronald Reagan Medical Center
University of California Los Angeles Division of Plastic & Reconstructive Surgery
Disclosure of Relevant Financial Interests for All
Authors“Nothing to disclose”
University of California Los Angeles Division of Plastic & Reconstructive Surgery
Severe Lower Eyelid Scarring
Trilamellar Lower Eyelid Reconstruction
Post-traumatic Lower Eyelid Scar
Traumatic violation of all three lamellae leads to severe scarring
Post-traumatic full-thickness lower eyelid injury
Post-surgical: Trans-conjunctival incision after partial thickness anterior scar
University of California Los Angeles Division of Plastic & Reconstructive Surgery
Objective
Trilamellar Lower Eyelid Reconstruction
Post-surgical Lower Eyelid Scar
Evaluate staged operative approach for symptomatic improvement
University of California Los Angeles Division of Plastic & Reconstructive Surgery
Methods
Trilamellar Lower Eyelid Reconstruction
First Stage:• Palatal Graft
Mid/Posterior lamellae• FTSG Anterior lamella
Second Stage:• Fat grafting Spacer
University of California Los Angeles Division of Plastic & Reconstructive Surgery
Methods
Trilamellar Lower Eyelid Reconstruction
First Stage:• Palatal Graft
Mid/Posterior lamellae• FTSG Anterior lamella
Second Stage:• Fat grafting Spacer
University of California Los Angeles Division of Plastic & Reconstructive Surgery
Methods
Trilamellar Lower Eyelid Reconstruction
First Stage:• Palatal Graft
Mid/Posterior lamellae• FTSG Anterior lamella
Second Stage:• Fat grafting Spacer
University of California Los Angeles Division of Plastic & Reconstructive Surgery
Methods
Trilamellar Lower Eyelid Reconstruction
First Stage:• Palatal Graft
Mid/Posterior lamellae• FTSG Anterior lamella• Canthopexy
Second Stage:• Fat grafting Spacer
University of California Los Angeles Division of Plastic & Reconstructive Surgery
Cadaveric Anatomic Dissection
Trilamellar Lower Eyelid Reconstruction
Cross-section / Reconstruction
Showed consistent anatomy
Tarsal plate=10-12 mm
Palatal graft support
but pliable orbital rim
PG
Cadaver specimens (n=20)
University of California Los Angeles Division of Plastic & Reconstructive Surgery
UCLA Clinical Review
Trilamellar Lower Eyelid Reconstruction
Lower eyelid reconstruction (1999-2008)
(n=52)
1. Ectropion (eversion): 51%
2. Entropion (inversion): 30%
3. Full-thickness Scar: 19% or n=10
Underwent described staged technique
University of California Los Angeles Division of Plastic & Reconstructive Surgery
Results
Trilamellar Lower Eyelid Reconstruction
Mechanism: 75% Full-thickness injury 25% After transconjunctival incision with
partial injury
MVA = 60% Assault = 40%
Preoperative Postoperative
University of California Los Angeles Division of Plastic & Reconstructive Surgery
Results
Trilamellar Lower Eyelid Reconstruction
Timing: 9.1 months after injury (range=6-17 mths)
Procedures: 2.6 required
Preoperative Postoperative
University of California Los Angeles Division of Plastic & Reconstructive Surgery
Results
Trilamellar Lower Eyelid Reconstruction
Symptoms: Preop: Epiphora (90%), tearing (100%), redness
(100%), Blurring vision (80%), dryness (80%) Postop: Epiphora (0%), tearing (0%), redness
(0%), Blurring vision (10%), dryness (20%)
Preoperative Postoperative
University of California Los Angeles Division of Plastic & Reconstructive Surgery
Results
Trilamellar Lower Eyelid Reconstruction
Complications: (40%)
1. Redundant palatal graft (office excision)
2. Partial loss FTSG (healed secondarily)
3. Cellulitis after fat graft (resolved abx)
Preoperative Postoperative
University of California Los Angeles Division of Plastic & Reconstructive Surgery
Conclusions
Trilamellar Lower Eyelid Reconstruction
Our staged approach for reconstruction of scarred/displaced lower eyelid provided symptomatic improvement.
We suggest caution with transconjunctival approach following partial lower eyelid injury.
