Medial Kantal Bölge Cilt Defektlerinde Rekonstrüksiyon Alternatifleri

Year 2014, Volume: 22 Issue: 3, 96 - 100, 01.12.2014

Candemir Ceran Ersin Akşam Düriye Deniz Demirseren Berrak Akşam Mustafa Erol Demirseren

Abstract

Giriş: Medial kantal bölge cilt kanserlerinin sık görüldüğü, estetik ve fonksiyonel açıdan önemli bir bölgedir. Bu bölge defektleri nadiren travma, enfeksiyon ve yanık nedeniyle ortaya çıksa da en sık tümör eksizyonu sonucu oluşmaktadır. Bu çalışma medial kantal bölge defektlerinde kullanılan rekonstrüksiyon yöntemlerini incelemek amacıyla yapılmıştır. Gereç ve Yöntem: Kliniğimizde son on yıl içerisinde tedavi edilen medial kantal bölge tümörü olguları yaş, cinsiyet, histopatolojik tanı ve rekonstrüksiyon yöntemleri açısından geriye dönük olarak incelendi. Bulgular: Ortalama yaşları 60.7 olan 61 hastada defektlerin ortalama boyutları 1.0 x 0.7 cm olarak ölçüldü. Defektlerin onarım yöntemleri geriye dönük olarak değerlendirildiğinde; 13 primer onarım, 15 tam kalınlıktaki deri grefti, 21 alın bölgesinden lokal flep, 14 yanak bölgesinden lokal flep ve bir hastanın burun bölgesinden planlanan flep ile onarıldığı tespit edildi. Sonuçlar: Medial kantal bölge defektlerinin rekonstrüksiyonunda estetik açıdan renk ve doku uyumu iyi olan, kılsız deri içeren ve doğal konkaviteyi bozmayacak bir yöntem seçilmelidir. Ayrıca fonksiyonel açıdan distorsiyona, ektropiyona ve epiforaya sebep olmayacak şekilde planlama yapılmalıdır. Primer onarılamayacak büyüklükte ve tam kalınlıkta deri grefti ile onarıma uygun olmayan defektlerde en iyi tercih lokal fleplerdir.

Keywords

medial kantal bölge, rekonstrüksiyon, tümör eksizyonu, glabellar flep, bilobe flep

Reconstruction Alternatives of Medial Canthal Region Skin Defects

Abstract

Introduction: Medial canthal region is an important anatomical region both aesthetically and functionally and it is also a common location for skin malignancies. Medial canthal region skin defects most commonly occur after tumor excisions. This study was designed to evaluate reconstruction alternatives of medial canthal region skin defects. Material and Methods: Reconstruction methods of medial canthal region skin defects performed in our clinic in the last decade reviewed retrospectively. Age, sex, histopathological findings of the patients and reconstructive methods were evaluated. Results: Medial canthal region skin defects of 61 patients with a mean age of 60.7 was reconstructed in our clinic. Mean size of the defects were 1.0 x 0.7 cm. When the methods of reconstruction evaluated retrospectively; 13 defects were primarily closed, 15 defects were covered with full thickness skin grafts, 21 defects were reconstructed with local flaps from forehead region, 14 defects reconstructed with local flaps from cheek region and one defect was reconstructed with a flap from nasal region. Conclusions: The principles of the reconstruction is to ensure color and tissue match with a non hair bearing skin that prevents distortion, ectropion and epiphora while preserving the natural concavity of the medial canthal region. When the defects are not suitable for primary closure or full thickness skin grafting, local flaps are the best options.

Keywords

medial canthal region, reconstruction, tumor excision, glabellar flap, bilobed flap

References

• Inkster C, Ashworth J, Murdoch JR, Montgomery P, Telfer nR, 1.
• Leatherbarrow B. Oculoplastic reconstruction following Mohs
• surgery. Eye 1998;12:214-8.
• Onishi K, Maruyama Y, Okada E, Ogino A. Medial canthal recon- 2.
• struction with glabellar combined Rintala flaps. Plast Reconstr
• Surg 2007;119(2):537-41.
• Mutaf M, Günal E. A new Alternative for Reconstruction of the 3.
• Inferior Medial Canthal and nasal Sidewall Defects. J Craniofac
• Surg 2011;22(5):1793-5.
• Turgut G, Ozcan A, Yeşiloğlu n, Baş L. A new glabellar flap 4.
• modification for the reconstruction of medial canthal and na
• sal dorsal defects: “flap in flap” technique. J Craniofac Surg. 2009;20(1):198-200.
• Karşdağ S, Sacak B, Bayraktaroglu S, Ozcan A, Ugurlu K, Bas L. 5.
• A novel approach for the reconstruction of medial canthal and
• nasal dorsal defects: frontal hairline island flap. J Craniofac Surg. 2008;19(6):1653-7.
• Kilinc H, Bilen BT. Supraorbital artery island flap for periorbital 6.
• defects. J Craniofac Surg. 2007;18(5):1114-9.
• Emsen IM, Benlier E. The use of the superthinned inferior pedi- 7.
• cled glabellar flap in reconstruction of small to large medial can
• thal defect. J Craniofac Surg. 2008;19(2):500-4.
• Başterzi Y, Sar A, Unal S, Demirkan F, Arslan E. Versatility of fron- 8.
• tal island flaps in the reconstruction of periorbital soft tissue de
• fects. J Craniofac Surg. 2007;18(5):1108-13.
• Jelks GW, Glat PM, Jelks EB, Longaker MT. Medial canthal recon- 9.
• struction using a medially based upper eyelid myocutaneous
• flap. Plast Reconstr Surg. 2002;110(7):1636-43. 10. Spinelli HM, Jelks GW. Periocular reconstruction: a systematic
• approach. Plast Reconstr Surg. 1993;91(6):1017-24. 11. Spinelli HM, Shapiro MD, Wei LL, Elahi E, Hirmand H. The Role
• of Lacrimal Intubation in the Management of Facial Trauma and
• Tumor Resection. Plast Reconstr Surg. 2005;115(7):1871-6. 12. Behroozan DS, Goldberg LH. Upper eyelid rotation flap for re
• construction of medial canthal defects. J Am Acad Dermatol.
• ;53(4):635-8. 13. Meadows AE, Manners RM. A simple modification of the glabel
• lar flap in medial canthal reconstruction. Ophthal Plast Reconstr
• Surg. 2003;19(4):313-5. 14. Perry JD, Taban M. Superiorly based bilobed flap for inferior me
• dial canthal and nasojugal fold defect reconstruction. Ophthal
• Plast Reconstr Surg. 2009;25(4):276-9. 15. Lalonde DH, Lalonde J, French R. The no Vertical Scar Breast Re
• duction: A Minor Variation That Allows You to Remove Vertical
• Scar Portion of the Inferior Pedicle Wise Pattern T Scar. Aesth
• Plast Surg 2003;27:335–44. 16. Yenidunya MO, Demirseren ME, Ceran C. Bilobed flap recon
• struction in infraorbital skin defects. Plast Reconstr Surg. 2007;119(1):145-50.