Reconstruction of Complex Defects of the Eyelids and Periorbital Region

Background: Eyelids and periorbital region defects constitute a serious problem and significant challenge in the reconstruction surgery due to difficulty in restoring the anatomy and the function of the eyelid as well as the aesthetic appearance. Urgent management is mandatory in all cases. Then reconstructive plans is designed to restore the anatomy of the missing part, as well as the different modalities of reconstruction. Aim: To evaluate the aesthetic and functional results after reconstruction of the eyelids and periorbital defects by different reconstructive techniques. Patients and Methods: This study was conducted on 64 patients with defects of the eyelids and periorbital region. All patients underwent a full detailed history, complete ocular examination, visual acuity assessement, photography and radiological investigations. Treatment of 45 patients was done by local flaps, 15 patients by free skin grafts and 4 patientsby distant flaps. Results: Patients were evaluated as regards the aesthetic outcomes and functional results. The results were excellent in those patients treated by local flaps or free skin grafts. The distant flaps are used when the defect is large and the local tissues are not sufficient. In patients treated by split thickness grafts the results were excellent in 66%; good in 32% andpoor in 2%. In patients treated by local flaps the results wereexcellent in 60% and good in 40%. In patients treated bydistant flaps the results were excellent in 52%; good in 43% and poor in 5%. The functional results were excellent in all patients except 4 patients treated by local flaps and requiredadditional split thickness skin graft to correct a mild degreeof ectropion. Conclusion: Reconstruction of the eyelids defects must be treated urgently to avoid the serious complications resulting from exposure of the ocular surface and also to regain the cosmetic appearance of the face. The various methods presented in this study may be a guide to help in reconstructionof the periocular area. It is of utmost importance to maintainmobility of the upper eyelid and stability of the lower eye lidwhile addressing their reconstruction.