Optimizing the Periosteal Flap for Lateral Eyelid优化侧眼睑骨膜瓣.pptVIP

Optimizing the Periosteal Flap for Lateral Eyelid Reconstruction W. Thomas McClellan, M.D., WVU Clinton McCord, M.D., Emory Rebecca Neusch, WVU Nothing to Disclose Objective of the Study To establish a standardized method to harvest the periosteal flap in order to improve eyelid strength, position, and reduce ectropion. Materials 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). Materials 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. Materials 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. Materials and Methods - Design Materials and Methods Once 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. Surgical Images Figure 1 Pre-Op 80% lower eyelid + canthal Defect Figure 2 Intra-Op periosteal flap dissection Surgical Images Figure 3 Periosteal flap reflected to bridge the posterior lamellar defect Post-Operative Images Figure 4 Post-Operative Frontal View Figure 5 Post-Operative Oblique View Results and Conclusions 12 patients all with good outcomes There were no complications such as canthal dehiscence, cicatrical ectropion or entropion. Results and Conclusion The periosteal flap is an ideal flap to repair the lateral canthus and lateral posterior lam