Alt Göz Kapağı Tam Kat Defektlerinin Süperfisial Temporal Arter Ada Flebi ile Rekonstrüksiyonu

Öz

Amaç: Alt göz kapağı tam kat defektleri keratopati, korneal ülserasyon hatta körlüğe varan komplikasyonlara sebep olabileceğinden rekonstrüksiyonu önem arz eder. Makalede, tümör eksizyonu sonrası oluşan alt göz kapağı tam kat defektlerinin superfisial temporal arter ada flebi ve kulak kıkırdak grefti ile rekonstrüksiyonu sunulmuş ve tecrübelerimiz aktarılmıştır. Gereç ve Yöntemler: 2011-2013 yılları arasında toplam 5 hastaya, alt göz kapağında yerleşimli bazal hücreli kanser tanısıyla tümör eksizyonu yapılmış ve olguların alt göz kapağı süperfisial temporal arter ada flebi ve kulaktan alınan kıkırdak kompozit greft ile rekonstrükte edilmiştir. Bulgular: İki hastada operasyon sonrası venöz konjesyon görüldü ve kendiliğinden geriledi. Tüm hastalarda fonksiyonel ve estetik olarak başarılı bir rekonstrüksiyon sağlandı. Sonuç: Sonuç olarak; süperfisial temporal arter ada flebi geniş pedikül rotasyon arkının olması, renk ve doku uyumunun iyi olması, donör alan skarının az olması ve minimal morbiditesi ile alt göz kapağı tam kat defektlerinin rekonstrüksiyonunda kullanılabilecek güvenli bir seçenektir

Anahtar Kelimeler

• Alt göz kapağı defekti, Kulak kıkırdak grefti, Süperfisial temporal arter ada flebi

Reconstruction of Full-Thickness Lower Eyelid Defect Using a Superficial Temporal Artery Island Flap

Abstract

Objective: Lower eyelid reconstruction is important as lower eyelid full thickness defects can lead to keratopathy, corneal ulceration or even blindness. In this article, we describe the reconstruction of lower eyelid full thickness defects after tumor excision with a superficial temporal artery island flap combined with auricular composite cartilage graft and our experience is reported. Material and Methods: Between 2011 and 2013, 5 patients were diagnosed with basal cell carcinoma located in the lower eyelid. The tumor was excised and was reconstructed with a superficial temporal artery island flap combined with auricular composite cartilage graft.Results: Early postoperative venous congestion occurred in two patients and regressed spontaneously. A functionally and aesthetically successful reconstruction was achieved in all patients.Conclusion: A superficial temporal artery island flap is a reliable method for the reconstruction of full-thickness lower eyelid defects because of its wide pedicle rotational arc, resulting good eyelid contour with color and texture match, limited donor-site scar, and minimal postoperative morbidity

Keywords

• Lower eyelid defect, Auricular cartilage graft, Superficial temporal artery island flap

Kaynakça

1. Gorney M, Falces E, Jones H, Manis JR. One stage reconstruction of substantial lower eyelid margin defects. Plast Reconstr Surg 1969;44:592-6.
2. Zook EG, Van Beek AL, Russel RC, Moore JB. V-Y advancement flap for facial defects. Plast Reconstr Surg 1980;65:786-97.
3. Porfiris E, Kalokerinos D, Christopoulos A, Damilakos P, Ioannidis A, Georgiou P. Upper eyelid island orbicularis oculi myocutaneous flap for periorbital reconstruction. Ophthal Plast Reconstr Surg 2000;16:42-4.
4. Matsumoto K, Nakanishi H, Urano Y, Kubo Y, Nagae H. Lower eyelid reconstruction with a cheek flap supported by fascia lata. Plast Reconstr Surg 1999;103:1650-4.
5. Codner MA, McCord CD, Mejia JD, Lalonde D. Upper and lower eyelid reconstruction. Plast Reconstr Surg 2010;126:231-45.
6. Uchinuma E, Sakurai H, Shioya N. Anterofrontal superficial temporal artery island flap for full-thickness eyelid reconstruction. Ann Plast Surg 1989; 23: 433-6.
7. Eser C, Kesiktaş E, Gencel E, Tabakan İ, Yavuz M. Total or Near-Total Lower Eyelid Defect Reconstruction Using Malar Myocutaneous Bridge and Nasojugal Flaps and Septal Chondromucosal Graft. Ophthalmic Plast Reconstr Surg. 2016; 32:225-9.
8. Nakajima H, Imanishi N, Minabe T. The arterial anatomy of the temporal region and the vascular basis of various temporal flaps. Br. J. Plast. Surg. 1995; 48: 439- 50.

9. Pinar YA, Govsa F. Anatomy of the superficial temporal artery and its branches: Its importance for surgery. Surg Radiol Anat 2006;28:248-53.
10. Kajikawa A, Ueda K. Bilateral eyebrow reconstruction using a unilateral extended superficial temporal artery flap. Ann Plast Surg 2003;50:416-9.
11. Bozkurt M, Kulahci Y, Kapi E, Karakol P. A new design for superficial temporal fascial flap for reconstruction of the eyebrow, upper and lower eyelids, and lacrimal system in one-stage procedure: Medusa flap. Ann Plast Surg 2009;63:636-9.
12. Cöloğlu H, Koçer U, Oruç M, Sahin B, Ozdemir R. Axial bilobed superficial temporal artery island flap (tulip flap): Reconstruction of combined defects of the lateral canthus including the lower and upper eyelids. Plast Reconstr Surg 2007;119:2080-7.
13. Yang M, Zhao Y. Reconstruction of full-thickness lower eyelid defect using superficial temporal artery island flap combined with auricular cartilage graft. J Craniofac Surg 2015;26:576-9.
14. Harma M, Asko-Seljavaara S. Temporal artery island flap in reconstruction of the eyelid. Scand J Plast Reconstr Surg Hand Surg 1995;29:239-44.
15. Zheng Y, Zhao J, Wang X, Yi C, Xia W, Li Y, Ma X. The application of axial superficial temporal artery island for repairing the defect secondary to the removal of the lower eyelid basal cell carcinoma. Br J Oral Maxillofac Surg 2014;52:72-5.