Periocular reconstruction: a systematic approach

The records and photographs of 90 patients who underwent reconstructive procedures on the eyelids, canthi, and periocular tissues between 1982 and 1988 were reviewed retrospectively. The defects created by either fresh tissue histologically controlled resection or primary excision were analyzed according to location, size, and degree of resection and visual status. Histologic types included nodular, morphea, and fibrosing basal cell carcinomas; well to poorly differentiated squamous cell carcinoma; and melanoma in situ. The adequacy of both ocular protection and tissue preservation was assessed between 1 and 6 years postoperatively. Anatomic as well as functional reconstructions were performed with a complication rate of 12 percent. There were two tumor recurrences requiring extensive craniofacial extirpation and reconstruction. A systematic method of classifying periocular defects was developed in order to analyze various reconstructive options as well as the type and frequency of complications encountered. This classification system is applicable to primary benign and malignant lesions as well as defects. Analysis of patients who underwent periocular reconstruction in the context of this classification system reveals that larger defects and those involving the medial canthus are more prone to complications. Recurrent complications in the medial and lateral canthal region underscore the necessity of routinely utilizing ancillary procedures such as lacrimal intubation and canthopexy. Recommendations for periocular reconstruction are suggested based on this classification system.