Reconstruction Of Total Upper Eyelid With Prefabricated, Capsule-Lined Advancement Flaps: A Preliminary Study In Rabbit Model

Reconstruction of Total Upper Eyelid with Prefabricated, Capsule-Lined Advancement Flaps:A Preliminary Study in Rabbit ModelObjective:to repaire total upper eyelid defects with prefabricated capsule-lined advancement flaps in a experimental model in rabbits.Background:Total upper eyelid defect is a rare problem following tumor excision, trauma, and burns. Reconstruction of a total upper eyelid defect involves the reconstruction of two fundamental elements:anterior and posterior lamellae. The authors have observed that an expander capsule looks like the palpebral conjunctiva with a moist, smooth, white glistening appearance. The authors, therefore, experimentally repaired total upper eyelid defects with prefabricated capsule-lined advancement flaps in rabbits.Methods:Thirty-one tissue expanders were implanted into the foreheads of thirty-one rabbits. After 6 to 8 weeks, the prefabricated advancement flaps were designed to reconstruct rectangular excisions of the upper eyelid. Histopathology was evaluated at 3 days,1 week,2 weeks,1 month,2 months, and 4 months following reconstruction. The shortening of the upper palpebral edges was measured after 4 months of reconstruction as a one-dimension reference point of flap contracture.Results:No edema, congestion, infection, corneal damage, or necrosis were observed during the reconstructions. Histopathologic studies revealed that the long-term capsule had a normal conjunctiva-like appearance with a stratified columnar epithelium. The average shortening, measured as the length between inner to outer canthal folds, was inconspicuous.Conclusion:The capsule successfully served as a conjunctival substitute in a rabbit model of full-thickness lid defects after total eyelid excision. The eyelid appearance was satisfactory with ideal color and skin thickness. The expander capsule was a temporary conjunctiva/mucosa substitute providing a physical shield, an infection barrier, and a matrix for epithelialization simultaneously with a gradual capsular resolution.Within weeks, the capsules were transformed into a microscopically normal-appearing conjunctiva/mucosa.Objective:To study a improved technique by releasing orbicularis retaining ligament in orbicularis oculi muscle supension blepharoplasty. Release orbicularis retaining ligament could cut off the contact between orbitomalar skin and periosteum at inferior orbital rim, and carry the point of tightening orbitomalar skin in orbicularis oculi muscle supension blepharoplasty.Methods:There were 409 patients with apparent orbitmalar fold. The methods of releasing orbicularis retaining ligament and orbital septum fixation were added to advance the orbicularis oculi muscle supension blepharoplasty.Results:409 cases were treated using this method over the past 3 years. All results were satisfactory. No complications were observed.Conclusion:This improved method of orbicularis oculi muscle supension blepharoplasty is useful for orbitomalar skin rolling, especially for orbitmalar fold. The release allows effective redraping and upward mobilization of the orbicularis of the lower lid and the premalar soft tissues. This method is a simple and effective procedure for the correction of tear trough deformity and well-demarcated lid/cheek junction in lower eyelid belpharoplasty. This technique was easily performed with high security. It is one of the best choices for lower eyelid blepharoplasty.