The addition of a conjunctival flap to a posterior lamella auricular cartilage graft: A technique to avoid corneal complications

2021 ◽  
pp. 112067212199891
Author(s):  
Constanza Barrancos ◽  
Ignacio García-Cruz ◽  
Beatriz Ventas-Ayala ◽  
Marco Sales-Sanz
Keyword(s):  
Donor Site ◽  
Lower Eyelid ◽  
Cartilage Graft ◽  
Auricular Cartilage ◽  
Inferior Margin ◽  
Conjunctival Flap ◽  
Absorbable Sutures ◽  
Inferior Border ◽  
Superior Portion ◽  
Superior Border

Purpose: To present the benefits of the addition of a conjunctival flap when correcting lower eyelid retraction using an auricular cartilage graft. Methods: An auricular cartilage graft was obtained either from the concha o the scaphoid fossa. When preparing the receiving bed, the conjunctival incision was made 2 mm below the inferior margin of the lower eyelid tarsus, therefore, a conjunctival flap arising from the inferior border of the tarsus was obtained. The cartilage graft was placed in the lower eyelid. The inferior border of the graft was sutured to the retractors and conjunctiva using absorbable sutures. The superior border was sutured to the inferior tarsus, so that de conjunctival flap covered the superior portion of the graft. Results: Fourteen patients underwent the surgical technique. No corneal complications were observed in the early or late postoperative period. Donor site complications were not encountered. Conclusions: The confection of a conjunctival flap that lines the superior portion of an auricular cartilage graft in the lower eyelid provides protection against corneal postoperative complications until the graft is epithelized.

Auricular Cartilage

2019 ◽  
pp. 91-94
Author(s):  
Ali Sajjadian
Keyword(s):  
Postoperative Pain ◽  
Donor Site ◽  
Graft Material ◽  
Cartilage Graft ◽  
Septal Perforation ◽  
Auricular Cartilage ◽  
Structural Support ◽  
First Choice ◽  
Graft Donor ◽  
Ear Cartilage

The ear is generally not a first choice as a cartilage graft donor site for several reasons, none of which is valid. When the graft is harvested anteriorly, the scar is well-concealed as long as the incision is placed within the rim of the conchal bowl. And, although no site can provide as much cartilage as the rib, the auricle can provide a surprisingly large amount of graft material. There is also characteristically minimal morbidity with the harvest of auricular cartilage. This distinguishes it from rib cartilage harvest, which may be accompanied by significant postoperative pain and occasionally pneumothorax. In addition, septal harvest may cause bleeding, saddling of the nose symptomatic of septal perforation, and other airflow disturbances. The most important and major problem with ear cartilage is the flaccidity inherent in its structure. This makes it a poor choice when significant structural support is mandatory.

scholarly journals Long-Term Results of Autologous Auricular Cartilage Graft Applied in Anophthalmic Orbits Unable to Wear Prosthesis

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Yi-Lin Liao ◽  
Shu-Ya Wu ◽  
Yueh-Ju Tsai
Keyword(s):  
Donor Site ◽  
Donor Site Morbidity ◽  
Long Term Results ◽  
Chang Gung Memorial Hospital ◽  
Cartilage Graft ◽  
Auricular Cartilage ◽  
Prosthesis Fitting ◽  
Prosthesis Retention

In anophthalmic patients, shallow lower fornices make wearing ocular prostheses impossible and maintaining normal social activities difficult. This study retrospectively investigated the long-term surgical outcomes of autologous auricular cartilage grafting for contracted orbits. From 1995 to 2013, 29 anophthalmic contracture sockets with inadequate lower fornices and poor prosthesis retention presented to Chang Gung Memorial Hospital in Linkou, Taiwan, were treated using this surgical method. The success rate, aesthetic outcome, recurrence, and complications were analyzed. Among the 29 patients, 15 were women, 14 were men, their mean age was 45 years, and the mean follow-up time was 52 months (range = 6–159 months). Satisfactory lid position was achieved in 25 cases (86%), and lower fornix retraction recurred in four cases (14%). Neither donor site morbidity nor auricular deformity was noted during the follow-up period. Therefore, an auricular cartilage graft can be used successfully as a compatible spacer for anophthalmic patients with shallow lower fornices and prosthesis-fitting problems in long-term follow-up.

scholarly journals Cartilage Graft Donor Site Morbidity following Rhinoplasty and Nasal Reconstruction

2018 ◽  
Vol 11 (4) ◽  
pp. 278-284 ◽  
Author(s):  
Thuy-Van Tina Ho ◽  
Kevin Sykes ◽  
J.David Kriet ◽  
Clinton Humphrey
Keyword(s):  
Donor Site ◽  
Donor Site Morbidity ◽  
Nasal Reconstruction ◽  
Cartilage Graft ◽  
Nasal Surgery ◽  
Auricular Cartilage ◽  
Donor Site Pain ◽  
Graft Donor ◽  
Ear Cartilage ◽  
Site Pain

Although surgical techniques for rhinoplasty and nasal reconstruction are well established, prospective research on postoperative morbidity remains limited. The aim of this pilot study was to assess costal and auricular cartilage donor site pain and morbidity in patients undergoing rhinoplasty and nasal reconstruction. In this prospective cohort study, we enrolled 55 patients undergoing nasal surgery that required costal or auricular cartilage harvest from February 2015 through May 2016. Each patient was given a symptom-specific patient survey that assessed general pain, nasal pain, graft donor site pain, graft donor site itching, color variation, skin stiffness and thickness, and graft donor site appearance at 1, 4, and 12 weeks after surgery. Our patient group was 55% female ( n = 30); the mean age was 47 years. Rib cartilage graft patients had significantly greater nasal pain than cartilage donor site pain. There was no significant difference in rib versus ear cartilage donor site pain. Nearly all patients reported that they were not at all concerned about their scar appearance or ear shape and appearance. No prior studies compare cartilage donor site morbidity in patients undergoing nasal surgery. Our findings challenge the conventional wisdom that utilizing auricular and costal cartilage results in high levels of donor site pain. Surgeons should have a low threshold to harvest rib or ear cartilage when it can improve surgical outcome.

scholarly journals Conjunctival flap with auricular cartilage grafting: a modified Hughes procedure for large full thickness upper and lower eyelid defect reconstruction

2021 ◽  
Vol 14 (8) ◽  
pp. 1168-1173
Author(s):  
Ben Chen ◽  
◽  
Jia Liu ◽  
Xiu-Ying Zhu ◽  
Yan-Yan Lin ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Myocutaneous Flap ◽  
Lower Eyelid ◽  
Effective Procedure ◽  
Full Thickness ◽  
Auricular Cartilage ◽  
Tarsal Plate ◽  
Conjunctival Flap ◽  
The Mean ◽  
Cartilage Grafting

AIM: To investigate the suitability of a modified Hughes procedure, which consists of conjunctival flap with auricular cartilage grafting in reconstructing large full thickness upper and lower eyelid defect. METHODS: Patients with full thickness eyelid carcinoma involving more than 50% margin length who underwent surgical resection were retrospectively reviewed in the study. The defects were reconstructed using conjunctival flap with auricular cartilage grafting, covered with myocutaneous flap above. Followed-up time ranged from 12 to 24mo. Outcomes were classified as “good”, “fair”, and “poor” by evaluating the margin appearance, eyelid appearance, and complications. RESULTS: A total of 42 patients were enrolled in the study (26 males, 16 females, mean age, 68.6±7.7y, range: 53 to 82y). The mean defect widths measured 23.2±2.9 mm (range, 17 to 28 mm). The mean posterior lamellar defect height was 5.5±1.3 mm (4 to 8 mm). Thirty-seven patients had a “good” outcome (88.1%), 5 patients had a “fair” outcome (11.9%), and no one had a “poor” outcome. CONCLUSION: Conjunctival flap with auricular cartilage grafting and myocutaneous flap grafting is an effective procedure in reconstructing large full thickness upper and lower eyelid defect. It can not only achieve satisfied reconstruction, but also preserve intact tarsal plate of the opposite eyelid, avoiding retraction or entropion.

Treatment of Proptosis with Fat Removal Orbital Decompression in Graves’ Ophthalmopathy

1998 ◽  
Vol 8 (4) ◽  
pp. 246-252 ◽  
Author(s):  
J.P. Adenis ◽  
P.Y. Robert ◽  
J.G.H. Lasudry ◽  
Z. Dalloul
Keyword(s):  
Side Effects ◽  
Lower Eyelid ◽  
Ocular Motility ◽  
Orbital Decompression ◽  
Cartilage Graft ◽  
Retrospective Evaluation ◽  
Auricular Cartilage ◽  
Upper Eyelid ◽  
Fat Removal ◽  
Levator Aponeurosis

Purpose Retrospective evaluation of 41 proptosis reduction procedures using fat removal orbital decompression (FROD) according to a modified Olivari's technique. Methods Trans-septal excision of extraconal and intraconal fat was done under the microscope through the upper and lower eyelid blepharoplasty approach. Proptosis was measured with a Hertel exophthalmometer. Results Mean excision of 7.31 + 1.9 ml (range 3.25 - 12 ml) of orbital fat reduced proptosis on average by 4.7 + 2.4 mm (range 1–11 mm). Side effects were few, limited only to ocular motility disturbances. There was no significant effect on visual fileds. A postoperative drop in IOP was noted in patients with preoperative IOP above 21 mmHg. Efficient palpebral lengthening can be achieved with combined section of the levator aponeurosis horns in the upper eyelid, and/or auricular cartilage graft in the lower eyelid. Conclusions FROD reduces proptosis in Grave's ophthalmopathy.

scholarly journals Reconstruction of Combined Full-Thickness Defect of the Lateral Canthus and Lateral Upper and Lower Third Eyelids With an Extended Modification of the Fricke Flap, Periosteal Flap, and Conjunctival Flap

2019 ◽  
Vol 5 ◽  
pp. 2513826X1987945
Author(s):  
L. Ashley Griffin ◽  
Benjamin C. McIntyre
Keyword(s):  
Donor Site ◽  
Lower Eyelid ◽  
Temporal Region ◽  
Clinical Report ◽  
Periosteal Flap ◽  
Conjunctival Flap ◽  
Lateral Canthus ◽  
Aesthetic Appearance ◽  
Fricke Flap ◽  
Composite Defect

Introduction: The Fricke flap was originally described in 1829 as a laterally based flap from the temporal region that could be used to reconstruct potentially total lower eyelid defects. There have been a few minor modifications of this flap to allow for adjustments of the donor site scar, but none that address the sequelae of brow elevation and allow for reconstruction of a composite defect of the lateral canthus, lateral upper, and lower eyelids. We report our modification of the Fricke flap that allows for total reconstruction of these structures. Clinical Report: A 61-year-old male presented with composite defect of the lateral eyelids and canthus following resection of a basal cell carcinoma by Mohs technique. A Fricke flap was designed and modified to included elements of the above brow and below brow skin as an additional pennant flap. A “Y” shaped periosteal flap and inferior fornix conjunctival flap were also used to reconstruct the posterior lamella. Our surgical technique and follow-up are demonstrated. Discussion: Lateral eyelid and canthal reconstruction can be difficult to reconstruct with a single rotational flap from local sources. We describe our technique of modifying the Fricke flap to include an additional pennant of below brow skin that can be used to reconstruct the lateral eyelids and canthus allowing for a crisp lateral eyelid crease and acceptable donor site and aesthetic appearance. Conclusions: This is the first description of a modification of the Fricke flap that allows for total lateral eyelid and canthus reconstruction.

scholarly journals Total and Near Total Composite Lower Eyelid Defect Reconstruction with Glabella Flap: An Excellent Option with Limited Donor Site Availability

2021 ◽  
Vol 24 (4) ◽  
pp. 413-418
Author(s):  
Muhammad Omar Afzal ◽  
Yawar Sajjad ◽  
Kamran Khalid ◽  
Moazzam Nazeer Tarar
Keyword(s):  
Donor Site ◽  
Graft Infection ◽  
Case Series ◽  
Lower Eyelid ◽  
Total Loss ◽  
Cartilage Graft ◽  
Full Thickness ◽  
Traumatic Loss ◽  
Upper Eyelid ◽  
Thickness Loss

Background/Objective: Traumatic loss of the lower eye lid is usually combined with the paucity of adjacent flaps to reconstruct composite defects. We describe the use of Glabellar flaps with composite or cartilage graft to reconstruct total or near total composite lower eyelid defects and its outcome. Material and Methods: This case series was done from January 2017 to December 2019. Patients of either gender, with unilateral post traumatic partial or full thickness lower eyelid defect of 75% eyelid loss or more and Glabellar flap as only remaining option to reconstruct the anterior lamella were included. Patients with medial, lateral canthi, upper eyelid and injuries to orbital contents were excluded. The outcome was assessed on follow-up by the presence of epiphora, ectropion, lagophthalmos, obstruction of vision, graft infection/ extrusion, lower lid retraction, donor site scarring and the need for flap debulking. Results: 12 patients were operated for lower eyelid defects. 2 (16.7%) patients had total loss of eyelid, while 10 (83.3%) had near total loss, 7 (58.3%) patients presented with partial thickness loss of the eyelid, while rest presented with full thickness loss. 1 patient (8.3%) presented with epiphora, similarly 1 (8.3%) had obstruction of vision in down gaze and 1 (8.3%) had conjunctivitis. None had any other complaint. Conclusion: Glabellar flap together with composite or cartilage graft is an excellent option to reconstruct total or near total composite lower eyelid defects.

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