The Use of Axial Based Superficial Temporal Artery Frontal Branch Island Flap in Reconstruction of Full Thickness Extensive Lateral Canthus and Eyelid Defects

Amaç: Lateral kantus da dahil olmak üzere tam kat ve geniş göz kapağı defekti rekonstrüksiyonu, karmaşık ve kompleks yapının bir sonucu olarak zordur. Bu bölge defektlerini kapatmak, başarılı fonksiyonel ve estetik sonuçlar elde etmek için iyi vaskülarize cilt ve yumuşak doku önemli bir rol oynamaktadır. Hasta ve yöntem: Çalışmaya Manisa Celal Bayar Üniversitesi Tıp Fakültesi Hastanesi'nde Mayıs 2014-Aralık 2015 tarihleri arasında aksiyel süperfisyal temporal arter frontal dal ada flebi ile rekonstrüksiyon yapılan tam kalınlıkta göz kapağı ve lateral kantus defekti olan hastalar dahil edildi. Bulgular: Bu teknikle sekiz hasta ameliyat edildi. Beş tanesi kadındı. Ortalama yaş 66,1 ve ortalama takip süresi 11,8 ay idi. Dört hastada bazal hücreli karsinom, iki hastada skuamöz hücreli karsinom, bir hastada trikoblastik karsinom tespit edildi. Bir hastanın defekti ise travmaya sekonder idi. Bu teknikle toplam beş alt kapak total tam kat defekti, iki lateral kantus defekti ve bir total tam kat üst kapak defekti rekonstrükte edildi. Üç hastada flep donör alanı kısmi kalınlıkta deri grefti ile onarıldı. Bir hasta ameliyattan 6 ay sonra lateral kantal fissurun genişletilmesi için lateral kantoplastiye ihtiyaç duydu. Bir hasta ise ameliyattan 6 ay sonra hafif ektropiyona sekonder lateral kantopeksiye gereksinim duydu. Sonuç: Yüzeysel temporal arterin terminal frontal dalı bazlı ada flebi, palpebral konjonktiva rekonstrüksiyonu için mukoza grefti ve tars rekonstrüksiyonu için kıkırdak grefti gerekmeksizin kabul edilebilir estetik ve fonksiyonel onarım için güvenilir ve değerli bir seçenektir.

Objective: Full-thickness and extensive eyelid defect reconstruction including lateral canthus is complex and difficult as a result of complex structure of the area. To close defects in this region with good texture and to obtain successful functional and aesthetic results, good vascularized skin and soft tissue play an important role. Patient and methods: Patients with extensive full thickness eyelid and lateral canthus defects reconstructed with axial superficial temporal artery frontal branch island flap in Manisa Celal Bayar University Faculty of Medicine Hospital between May 2014 and December 2015 were included in the study. Results: A total of eight patients were operated with this technique. Five of them were female. Mean age was 66.1 and mean follow-up period was 11.8 months. Four patients had basal cell carcinoma, two had squamous cell carcinoma and one had trichoblastic carcinoma. One patients’ defect was secondary to trauma. Five total lower lid defects, two lateral canthus defects and one total upper lid defect were reconstructed with this technique. Flapdonor area of the three patients were reconstructed with split thickness skin graft. One patient needed lateral canthoplasty for lateral fissur widening 6 month after surgery and one patient needed lateral canthopexy secondary to mild ectropion 6 month after surgery. Conclusion: Island flap based on terminal frontal branch of the superficial temporal artery ensures a reliable and valuable option with acceptable aesthetic and functional coverage without need of cartilage graft for tarsus and mucosa graft for palpebral conjunctiva reconstruction.

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