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The maximal Hughes procedure.

A Maloof1, S Ng, B Leatherbarrow

  • 1Manchester Royal Eye Hospital, United Kingdom.

Ophthalmic Plastic and Reconstructive Surgery
|April 3, 2001
PubMed
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The Hughes procedure with periosteal flaps offers a safe and effective method for lower eyelid reconstruction in cases of maximal defects. This technique provides excellent eyelid contour and protection, potentially avoiding more complex surgical approaches.

Area of Science:

  • Ophthalmology
  • Plastic Surgery
  • Reconstructive Surgery

Background:

  • Maximal lower eyelid defects present significant reconstructive challenges.
  • The Hughes tarsoconjunctival flap is a well-established technique for lower eyelid reconstruction.
  • Augmentation with periosteal flaps may enhance stability and contour in extensive reconstructions.

Purpose of the Study:

  • To evaluate the efficacy of combining oblique medial and lateral periosteal flaps with the Hughes tarsoconjunctival flap for maximal lower eyelid defect repair.
  • To assess the aesthetic outcomes and surgical complications associated with this combined technique.

Main Methods:

  • A prospective case series involving eight patients with maximal lower eyelid defects.
  • Surgical reconstruction utilized a Hughes tarsoconjunctival advancement flap augmented with oblique medial and lateral periosteal flaps.

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  • Patients were evaluated for corneal protection, eyelid closure, retraction, aesthetic results, and complications.

    • Main Results:

    • All eight patients underwent uncomplicated surgery.
    • Excellent eyelid contour and corneal protection were observed in all cases.
    • One patient experienced mild lower eyelid retraction; another developed medial ectropion requiring revision.

    Conclusions:

    • The maximal Hughes procedure, augmented with periosteal flaps, is a safe and effective option for lower eyelid reconstruction.
    • This technique can achieve excellent outcomes and may obviate the need for more extensive reconstructive methods.
    • The procedure is suitable for performance under local anesthesia.