Erol KESİKTAŞ, Rauf KERİMOV, İbrahim TABAKAN, Cengiz ESER, Emrah Efe ASLANER

Alt Göz Kapak Rekonstrüksiyonundaki Klinik Deneyimlerimiz ve Rekonstrüksiyon Yöntemlerin Karşılaştırılması

Alt göz kapağında tümör eksizyonu veya travma sonrası oluşan defektlerin rekonstrüksiyonu, gözün korunması açısından çok önemlidir ve özellik arz eder. Bu çalışmada amaç, alt göz kapak defektlerinde uyguladığımız teknikleri değerlendirmektir. 1999-2009 yıllar arası 21’i tümör eksiyonu 2’si ise travma sonrası oluşan toplam 23 hastada alt göz kapağında oluşan defektler çeşitli tekniklerle onarıldı. Hastaların 11’i kadın 12’si ise erkek ve ortalama yaş 60.7 idi Onarım için 13 MustardÃ© flebi, 8 bipediküllü Tripier flebi, 1 Tenzel flebi ve 1 infraorbitalden hazırlanan bipediküllü flepler kullanıldı. Hastalar ameliyat sonrası ortalama 35 ay ( 18-47 ) süresince takip edildi. Hiçbir hastada flep nekrozu, kapakta fonksiyon kaybı gibi sorunlarla karşılaşılmadı ve estetik olarak tatminkar sonuçlar elde edildi. Alt göz kapak defektlerinin rekonstrüksiyonunda; defektin boyutu ve göz çevresindeki dokuların durumu değerlendirilmeli ve onarım bu kriterlere göre yapılmalıdır.

Anahtar Kelimeler:

Alt göz kapağı, rekonstrüksiyon, flep.

Our Clinical Experience in Lower Eyelid Reconstruction and Comparison of Reconstruction Techniques.

Lower eyelid reconstruction after tumor resection or trauma is extremely important in order to obtain the protection of the globe and it requires extra care. The aim of this study is to evaluate the techniques that we use in lower eyelid reconstruction. Between the years of 1999-2009, a total of 23 patients who had lower eyelid defects due to tumor resection (21 patients) or trauma (2 patients) were reconstructed by the use of various flaps. Eleven of the patients were women and twelve of them were men. Average age was 60.7. For the reconstruction 13 MustardÃ© flap, 9 bipedicled Tripier flap, 1 Tenzel flap and 1 bipedicled infraorbital flaps were used. Average postoperative follow up interval was 35 months. (18-47 months). Flap necrosis, function loss in the lower lid were not experienced in any of the patients. Cosmetically satisfactory results were obtained. In lower eyelid reconstruction, the size of the defect and the amount of skin around must be carefully evaluated and should be considered while planning the reconstruction.

Keywords:

lower eyelid, reconstruction, flap,

PDF

___

1. Aydın Y, Güzel Z, Taş T ve ark. Alt göz kapağı tümörlerinde Tripier fleple onarım. Cerrahpaşa Tıp Dergisi 2001; 32(3):163-168.
2. Banu MH, Özlem EV, Zeliha Y ve ark. Malign kapak tümörlerinde kapak rekonstrüksiyonu sonuçlarımız. T Klin Oftalmoloji 2001;10:165-170.
3. Carraway JH, Vincent MP. Reconstruction of eyelid deformities In: Gregory SG and Nicholas GG, eds. Textbook of Plast Maxillofacial and Reconstructive Surgery. Baltimo Williams and Wilkins, 1992, 2 nd ed. p. 551-65.
4. Carraway JH. Reconstruction of the eyelids and correction ptosis of the eyelid. In: Aston SJ, Beasley RW, Thorne HC (eds): Grabb and Smith’s Plastic Surgery. New York: Lippinco Raven, 1997, 5 th ed p.529-44.
5. Codner M.A. Reconstruction of the eyelids and orbit. Coleman, JJ in Plastic Surgery. London, Mosby, 2000, 1425p.
6. Güzel MZ., Yıldırım I, Aygit AC ve ark. Reconstruction of the total lower eyelid defect- Useful modifications. Eur J Plastic Surg 1995; 18: 171-174. 7. Kanski JJ. Disorders of eyelids. Clinical Ophthalmology. New Delhi: Butterworth-Heinemann, 4 th ed. 1999, p.1-41.
8. Kurul S, Özcan G, Yılmazlı C. Fricke supraorbital flap for reconstruction of total lower eyelid defects. Eur J Plast Surg 1989; 12: 8-15.
9. Landolt, M. Nouveau procede blepharoplastie. Arch Ophthalmol (Paris) 1881; 1: 9.
10. Landolt. De quelques operations pratiquees surles paupires. Arch Ophthalmol (Paris) 1885; 5: 481.
11. Mustarde JC. Repair and Reconstruction in the Orbital Region. A Practical. Guide. New York, Churchill Livingstone Inc, 1980;
12. Patterson AR, Brady G, Walker PD, Telfer MR. The perichondrial cutaneous graft and \"flip-flop\" flap in facial reconstruction: a series of 41 cases. Br J Oral Maxillofac Surg 2008;46(2):114-118.
13. Siegel R.J. Severe ectropion: repair with a modified Tripier flap. Plast Rec Surg 1987; 80: 21-28. 14. Tenzel RR. Eyelid reconstruction by the semicircular flap technique. Ophthalmology 1978; 85:1164.
15. Tenzel RR. Semicircular flap in reconstruction of upper and lower eyelid defects. In: Berish Strauch, Luis O Vascones, Elizabeth J Hall Findlay (eds). Grabb’s Encyclopedia of Flaps. Boston: Little Brown and Company, 1990, 1 st ed p. 57-9.
16. Tripier L. Lombeau Musculocutane en forme de pont. Lancette Française Gaz Hospitaux 1889; 62: 1124.
17. Tripier L. Du double plan de lambeaux: Comme moyen de reparer certaines portes de substances interessent aíla fois les parties moles et le squette de la region sous orbitaire. Rev Chir 1890; 10: 149.
18. Van der Meulen JC. Senile ectropion. Plast Reconstr Surg 1988; 81: 642-643.