Following excision of eyelid tumours (for instance, by Mohs’ Micrographic Surgery) there is a defect in the eyelid which requires reconstruction.
Depending on which part of the eyelids and peri-orbita are affected different techniques are used for reconstruction. The options include ‘laissez-faire’, direct closure, flaps or grafts, or combination thereof.
- ‘Laissez-faire’ – this is used if there is a small, shallow tissue loss. It means that the defect is allowed to heal on its own, without any stitches.
- Direct closure is used if only a moderate amount of tissue is lost and the edges can be easily approximate.
- Flaps are used if there is a partial thickness eyelid defect which cannot be closed directly. Instead, adjoining tissue is borrowed in the form of a flap which has a good blood supply because it is still attached to its original harvest site.
- Grafts are used if the defect cannot be closed with a flap, or if the defect involves the full thickness of the eyelid. In such cases, a graft will be combined with a flap.
- Examples of tissue used for eyelid reconstruction grafts include skin, ear cartilage, mucosa from the roof of the mouth or the inside of the cheek, fascia from the scalp and fat from the abdomen.
Examples of tissue used for eyelid reconstruction flaps include part of the conjunctiva and tarsus, fascia from the scalp, muscle and skin from several areas. Eyelid reconsturction using flaps can be one or two stage operations.
If the canaliculus is damaged and reconstruction is required, a fine silicon tube may be used to keep the opening clear during the healing process.
The oculoplastic surgeon will assess the defect carefully and advise what combination of reconstructive techniques is appropriate. Oculoplastic surgeons are skilled in eyelid and periorbital reconstruction.
After reconstruction, a patient will be left with some stitches and those made in the skin will be removed within approximately seven to ten days.
The precise treatment is very much dependent on the type of injury. Although immediate eyelid repair is not always necessary, it is best to seek medical advice as soon as possible as even a small cut in the eyelid can lead to complications if not repaired properly. There may be a concealed foreign body or deeper injury. If there is no ocular involvement, eyelid and canalicular repair should be performed within three days of the injury. The surgical technique and type of anaesthetic used may differ according to the nature of the injury.
Simple eyelid lacerations not involving the tearduct are usually repaired under local anaesthetic with deep, absorbable sutures and often tiny sutures on the skin which can be removed five to ten days afterwards.
The canaliculus is often easier to repair 36-48 hours after the injury once swelling in the surrounding tissue has gone down. If a significant amount of tissue is lost after trauma or surgery it may not be possible to do a straightforward repair. On these occasions it may be necessary to use flaps or grafts to replace lost tissue. This approach prolongs the recovery period but has better long term results. If the canaliculus is damaged and reconstruction is required, a fine silicon tube may be used to keep the opening clear during the healing process (Mini Monaka® or bicanalicular Crawford tubes (r)).
An eyelid laceration which has not been properly sutured will have a misaligned appearance and require oculoplastic revision. The eyelid may have an ectropion due to scarring and require a skin graft taken from the patient’s upper eyelid or behind their ear, or alternatively a scar-lengthening z-plasty reconstruction.