Post-oncological full-thickness eyelid defect reconstruction: An aesthetical overview

Area of Science:

• Ophthalmology
• Plastic Surgery
• Oncology

Background:

• Full-thickness eyelid defects often result from tumor excision, necessitating complex reconstruction.
• Accurate defect localization and tailored surgical approaches are crucial for optimal aesthetic and functional outcomes.
• Existing methods for evaluating eyelid reconstruction success may not fully capture nuanced aesthetic and functional results.

Purpose of the Study:

• To introduce a novel, detailed aesthetical subunit (ASU) involvement chart for precise localization of eyelid defects.
• To evaluate the aesthetic and functional outcomes of full-thickness eyelid defect reconstruction surgery using a modified aesthetical rating guideline.
• To correlate surgical techniques with patient outcomes in post-oncological eyelid reconstruction.

Main Methods:

• Retrospective review of medical records for 31 patients with primary malignant full-thickness eyelid tumors.
• Analysis of patient demographics, pathological diagnosis, follow-up duration, and ASU involvement.
• Evaluation of reconstructed eyelid photos using a modified aesthetical rating guideline to assess aesthetic and functional results.

Main Results:

• The study identified 31 patients, with an overall mean aesthetic score of 3.5.
• Seventeen patients were categorized into the more aesthetically pleasing (AP) group (score > 3.5), and 14 into the less AP group (score < 3.5).
• The more AP group predominantly used myo-cutaneous flaps for anterior lamella repair, while the less AP group used multiple flap combinations. Posterior lamella reconstruction utilized tarso-conjunctival tissue in both groups. Notably, the more AP group experienced significantly higher scores for tissue scarring, lash line disruption, eyelid thickness, and retraction/ectropion (P<0.05). Fair eyelash color was also more prevalent in the more AP group (P=0.009).

Conclusions:

• The developed ASU involvement chart can aid surgeons in selecting optimal reconstruction methods for full-thickness eyelid defects.
• Surgical techniques impact both aesthetic and functional outcomes, with trade-offs between aesthetic results and complications like scarring and eyelid malposition.
• Further research can refine surgical strategies for eyelid reconstruction, balancing aesthetic goals with functional integrity.