Presentation on theme: "Optimizing the Periosteal Flap for Lateral Eyelid Reconstruction"— Presentation transcript:
1Optimizing the Periosteal Flap for Lateral Eyelid Reconstruction W. Thomas McClellan, M.D., WVUClinton McCord, M.D., EmoryRebecca Neusch, WVUNothing to Disclose
2Objective of the StudyTo establish a standardized method to harvest the periosteal flap in order to improve eyelid strength, position, and reduce ectropion.
3Materials and Methods - Design Create a central meridian from the upper puncta to the lateral orbital rim.This intersection point is where the superior aspect of the flap is started and continues at a 40 degree angle superiorly out a distance X (which is the length needed to repair the defect).
5Materials and Methods - Design The width of the flap should measure 6-7 mm which compensates for primary contracture while maintaining strength of the periosteum. The periosteum is then secured with 5-0 Vicryl to the lateral edge of the tarsal plate with enough tension that the lid approximates the globe.
6Materials and Methods - Design If the flap is extended onto the temporalis fascia up to 50% of the posterior lamella of the lower eyelid can potentially be closed.
7Materials and MethodsOnce the flap is secured, a Tenzel flap can be rotated to repair the anterior lamellar defect and sutured with 6-0 nylon and 5-0 plain gut near the line margin.Sutures are removed at 6 days.
11Results and Conclusions 12 patients all with good outcomesThere were no complications such as canthal dehiscence, cicatrical ectropion or entropion.
12Results and Conclusion The periosteal flap is an ideal flap to repair the lateral canthus and lateral posterior lamella due to its simplicity, reliability, and low risk.
13Results and Conclusion It can be designed to match the native eyelid contour, originates within the lateral orbit, is strong, and highly vascular2. Additionally if the flap relaxes with time it can be elevated and re-secured within the lateral orbit.
14Significance of the Findings This standardized method demonstrates a reliable method of reconstructing lateral eyelid defects. It optimizes lid position and reduces post operative ectropion.
15References1. Smith, B.C., Nesi, F.A. Practical Techniques in Ophthalmic Plastic Surgery. St. Louis: The C.V. Mosby Company, Pp 2. Weinstein GS, Anderson RL, Tse DT, Kersten RC. The use of a periosteal strip for eyelid reconstruction. Arch. Ophthalmol Mar;103(3):3. McCord, C.D. Jr., Codner, M.A. Eyelid and Periorbital Surgery, Vol.2, 1st Ed. St. Louis: Quality Medical Publishing, Inc., Pp