Meryem ALTIN EKİN, Şeyda KARADENİZ UĞURLU

ALT VE ÜST GÖZ KAPAĞI TAM KAT DEFEKTLERİNİN REKONSTRÜKSİYON SONUÇLARI: 10 YILLIK TEK MERKEZ DENEYİMİ

Amaç: Alt ve üst göz kapağı tam kat defektlerinin onarımında kullanılan rekonstrüksiyon tekniklerinin uzun dönem sonuçlarını değerlendirmek. Gereç ve Yöntem: Alt ve üst göz kapağı tam kat defektlerine rekonstrüksiyon işlemi uygulanan hastalar retrospektif olarak değerlendirildi. Kısmi kalınlıktaki defektler, saf kantal defektler ile flep gerektirmeden primer olarak onarılabilecek kapağın 1/3 ve daha azını tutan defektler çalışmaya dahil edilmedi. Malign kapak tümörü olan tüm hastalarda cerrahi sınırlar tümör negatif olacak şekilde eksize edildi. Kapak defektinin boyutu ve lokalizasyonuna göre belirlenen rekonstrüksiyon metodu uygulandı. Hastaların demografik özellikleri, lezyonların histopatolojisi, eksizyon sonrası defekt boyutu, uygulanan rekonstrüksiyon yöntemi, takip süresi, postoperatif komplikasyonlar, tümör rekürrensi, cerrahi sonrası kapağın fonksiyonel ve kozmetik sonuçları kayıt edildi. Takip süresince hastalar fonksiyonel ve kozmetik sonuçlar, postoperatif komplikasyonlar ve tümör rekürrensi açısından değerlendirildi. Bulgular: Çalışmaya 82 hastanın 84 gözü dahil edildi. Yaş ortalaması 67,5±13,5 yıldı. Ortalama izlem süresi 21,2±14,6 (3-80) aydı. Altmış üç (%75) hastaya alt kapak, 18 (%21,4) hastaya üst kapak ve 3 (%3,6) hastaya hem alt hem de üst kapak rekonstrüksiyonu yapıldı. Hastaların %65,4’ünde (n=55) bazal hücreli karsinom mevcuttu. 74 (%88,1) hastaya lokal flepler ile rekonstrüksiyon uygulanırken, 10 (%11,9) hastaya fleple birlikte greft kullanılarak rekonstrüksiyon gerçekleştirildi. Komplikasyon gelişen 15 (%17,9) hastanın 5’ine (%5,9) sekonder cerrahi girişim uygulandı. Hastaların %95,2’inde kozmetik sonuçlar, %96,4’ünde fonksiyonel sonuçlar tatmin ediciydi. Rekonstrüksiyon işlemi sonrası hiçbir hastada izlem süresince tümör rekürrensi izlenmedi. Sonuç: Alt ve üst göz kapağının tam kat defektlerinde uygun rekonstrüksiyon yöntemi kullanımı ile iyi fonksiyonel ve kozmetik sonuçları elde etmek mümkündür.

Anahtar Kelimeler:

Bazal hücreli karsinom, Göz kapağı rekonstrüksiyonu, Tam kat göz kapağı defekti

RECONSTRUCTION TECHNIQUES OF UPPER AND LOWER EYELID FULL THICKNESS DEFECTS: TEN-YEAR SINGLE CENTER EXPERIENCE

Objective: To evaluate long term outcomes of reconstruction techniques used for full thickness defects of upper and lower eyelids. Material and Method: Patients who had undergone reconstruction for full thickness eyelid defects were evaluated retrospectively. Partial thickness defects, defects which were less than 1/3 of the total size of the eyelid, and defects which could be repaired primarily without flap were excluded from the study. Surgical borders were excised with negative margins in malignant tumors. Reconstruction methods were performed according to the size and localization of eyelid defects. Demographic characteristics of patients, etiologies, reconstruction methods, sizes of the defects, pathology reports, follow-up times, postoperative complications, tumor recurrence, and surgical outcomes were recorded. Patients were evaluated for surgical outcomes, complications and tumor recurrence. Results: Eighty-four eyes of eighty-two patients were included in the study. The mean age was 67.5±13.5 years. The mean follow-up time was 21.2±14.6 (3-80) months. Reconstruction of lower eyelid was perfomed in 63 (75%) patients, upper eyelid in 18 (21.4%) patients and both lower and upper eyelid in 3 (3.6%) patients. Basal cell carcinoma was diagnosed in 65.4% (n=55) of patients. Reconstruction was performed using only flap in 74 (88.1%) patients and flap and graft in 10 (11.9%) patients. Among 15 (17.9%) patients with complications, 5 (5.9%) underwent secondary surgery. Cosmetic and functional outcomes were satisfactory in 95.2% and 96.4% of patients, respectively. Tumor recurrence was not observed during follow-up.Conclusion: In the full thickness defects of upper and lower eyelids, good functional and cosmetic outcomes can be achived using proper reconstruction methods.

Keywords:

Basal cell carcinoma, Eyelid reconstruction, Full thickness eyelid defect,

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