The Repair of the Periorbital Soft Tissue

Abstract

Aims: The aim of this study is to discuss the repair and reconstruction methods of the periorbital soft tissue. Material and method: Periorbital soft tissue repair was performed in 51 patients. Fifty-nine repairs or reconstructions were carried out in soft tissues by primary repair, skin graft, local flaps, Z-plasty, W-plasty. The causes of the repair were 17 basal cell carcinomas, 2 epidermoid carcinomas, 17 traumas, 11 benign lesions and 4 scar tissues. Results: Successful results were obtained in primary repairs when reciprocal places sutured. Local flaps were preferred in tissue defects because of similar structure. Full thickness skin graft harvested from the back of the ear was chosen firstly in skin graft repairing and color harmony was achieved. Glabellar flaps that performed without thinning in two cases were detected thick in this region. Conclusion: Periorbital area comprises many important units despite being a little portion in whole body. Desired functional and aesthetic results may be attained to know the anatomy of this area, good evaluation the lesion preoperatively and choose the suitable repair method.

Keywords

• -

Periorbital Yumuşak Dokuların Onarımı

Öz

Amaç: Bu çalışmada periorbital bölgenin yumuşak dokularının tamir ve rekonstrüksiyon yöntemlerinin tartışılması amaçlanmıştır. Gereç ve yöntem: 51 hastaya periorbital yumuşak doku onarımı yapıldı. Yumuşak dokulara primer tamir, deri grefti, lokal flebler, Z-plasti ve Wplasti ile 59 onarım ve/veya rekonstrüksiyon yapıldı. Onarım gerektiren nedenler 17 bazal hücreli karsinom, 2 epidermoid karsinom, 17 travma, 11 benign lezyonlar, 4 skar dokusuydu. Bulgular: primer tamirlerde dokular uygun yerlerine dikildiğinde başarılı sonuçlar alındı. Doku defektlerinde lokal flebler benzer özellik taşıdığından ilk olarak tercih edildiler. Greftle onarımlarda ilk tercih olarak kulak arkasından tam kalınlıkta deri grefti kullanıldı ve iyi renk uyumu sağlandı. 2 vakada inceltilmeden uygulanan glabellar flebler bu bölge için kalın bulundu. Sonuç: Periorbital bölge vücudun küçük bir kısmını oluşturmasına karşın bir çok önemli yapıları içermektedir. İstenilen fonksiyonel ve estetik sonuçlara ancak bu bölgenin anatomisinin iyi bilinmesi, ameliyat öncesi lezyonun iyi değerlendirmesi yapılması ve uygun onarım yöntemi seçilmesi ile ulaşılır.

Anahtar Kelimeler

• Periorbital bölge, yumuşak dokular, onarım şekilleri

Kaynakça

1. Spinelli HM, Jelks GW. Periocular reconstruction: a systematic approach. Plast Reconstr Surg 1993; 91: 1017-1024.
2. Klapper SR, Patrinely JR, Sopakar CNS. Eyelid reconstruction. In: Ewans GRD (Editor). Operative plastc surgery. California: McGraw-Hill, 2000: 241-254.
3. Ng SGJ, Inkster CF, Leatherbarrow B. The rhomboid flap in medial canthal reconstruction. Br J Ophthalmol 2001; 85: 556-559.
4. Glat PM, Longaker MT, Jelks EB ve ark. Periorbital melanocytic lesions: excision and reconstruction in 40 patients. Plast Reconstr Surg 1998; 102: 19-27.
5. Patrinely JR, Marines HM, Anderson RL. Skin flaps in periorbital reconstruction. Surv Ophthalmol 1987; 31: 249-261.
6. Manson PN. Assessment and management of facial injuries. In: Weınzweıg J (Editor). Plastic surgery secrets 2. Baskı, Philadelphia: Hanley Belfus, 1999; 130-135.
7. Lawrence CM, Comaish JS, Dahl MG. Excision of skin tumours without wound closure. Br J Dermatol 1986; 115: 563-571.
8. Lowry JC, Bartley GB, Garrity JA. The role of second-intention healing in periocular reconstruction. Ophthal Plast Reconstr Surg 1997; 13: 174-188.

9. Clodius L. Surgery for the facial port-wine stain: technique and results. Ann Plast Surg 1986; 16: 457-471.
10. Anderson RL, Edwards JJ. Reconstruction by myocutaneous eyelid flaps. Arch Ophthalmol 1979; 97: 2358-2362.
11. Carraway JH. reconstruction of the Eyelid and correction of ptosis of the eyelid. In Sj Aston, RW Beasley, CHM Thorne (Editors). Grabb and Smith’s Plastic Surgery. 73. Baskı, Philadelphia: Lippincott Raven Publishers, 1997: 529-544.
12. Jewett BS, Shockley WW. Reconstructive options for periocular defects. Otolaryngol Clin North Am 2001; 34: 601-625.
13. Pieh S, Kuchar A, Novak P ve ark. Long-term results after surgical basal cell carcinoma excision in the eyelid region. Br J Ophthalmol 1999; 83: 85-88.
14. Moy RL, Ashjian AA. Periorbital reconstruction. J Dermatol Surg Oncol 1991 ; 17: 153-159.
15. Borman H, Ozcan G. Superomedially based upper eyelid musculocutaneous flap for closure of medial canthal defects. Eur J Plast Surg 2001; 24: 239-242.
16. Fischer T, Noever G, Langer M, Kammer E. Experience in upper eyelid reconstruction with the Cutler-Beard technique. Ann Plast Surg 2001; 47: 338-342.
17. Scuderi N, Rubino C. Island chondro-mucosal flap and skin graft: a new technique in eyelid reconstruction. Br J Plast Surg 1994; 47: 57-59.
18. Porfiris E, Christopoulos A, Sandris P ve ark. Upper eyelid orbicularis oculi flap with tarsoconjunctival island for reconstruction of full-thickness lower lid defects. Plast Reconstr Surg 1999; 103: 186-191.
19. Durak N, Şimşek Ş, Yüksel F, Bekereci M, Karacaoğlan E. Alt Göz Kapağı Onarımlarında Fricke Flep'in Üstünlüğü. İstanbul Tıp Fakültesi Mecmuası 1998; 61: 4
20. Durak N, Şimşek Ş, Peker F, Bekereci M, Karacaoğlan E. Alt Göz Kapağı Kanserlerinde Cerrahi Tedavi Yöntemlerinin Karşılaştırılması. İstanbul Tıp Fakültesi Mecmuası 1999; 62: 1
21. Aydın Y, Güzel Z, Taş T, Kuyubaşı S, Yıldırım İ. Alt Göz Kapağı Tümörlerinde Trıpıer Fleple Onarım. Cerrahpaşa Tıp Dergisi 2001; 32: 163-168.
22. Mustarde JC. The use of flaps in the orbital region. Plast Reconstr Surg 1970; 45: 146-150.
23. Spinelli HM, Forman DL. Current treatment of post-traumatic deformities. Residual orbital, adnexal, and soft-tissue abnormalities. Clin Plast Surg 1997; 24: 519-530.
24. Hudson DA. Some thoughts on choosing a Z-plasty: the Z made simple. Plast Reconstr Surg 2000; 106: 665-671.
25. Juri J. Eyebrow reconstruction. Plast Reconstr Surg 2001; 107: 1225-1228.
26. Demir C Y, Köhle Ü. Periorbital Bölge Malign Cilt Tümörleri: Retrospektif Çalışma. Fırat Tıp Dergisi 2003; 8: 206-209.
27. Strong JW, Worsham GF, Hagerty RC. Peripheral in-continuity tissue examination: a modification of Mohs' micrographic surgery. Clin Plast Surg. 2004; 31: 1-4.
28. Lang PG Jr. The role of Mohs' micrographic surgery in the management of skin cancer and a perspective on the management of the surgical defect. Clin Plast Surg. 2004; 31: 5-31.
29. Kabul Tarihi:15.02.2005