10^th International Congress on Surgery May 22-23, 2019 Tokyo, Japan

Biography:

Devid Ruru is a Resident of General Surgery Department at Brawijaya University, Indonesia.

Abstract:

Gastroschisis is among the most common structural birth defects and its cause remains unknown. The phenomenon of increased prevalence has been reported and continues to be a stimulus for epidemiologic evaluation of risk factors, both maternal and environmental. This study seeks to profile infants with gastroschisis admitted to RSSA during the period of January 1^st 2015 until December 31^st 2016. The design of the study is a descriptive research design with samples of all gastroschisis patients treated at RSSA during the period January 1, 2015 until December 31, 2016 who met the inclusion criteria those patients who undergo therapy to completion. The medical records of samples collected and then do the recording of the variables studied. Results showed patients with gastroschisis occurred in 57% of men, 71% primigravida, 64% of term baby, 79% of low birth weight, average treatment duration of 8 days, the average length of stay of 9 days, the average maternal age 22.3 years, 93% were staged closure, 86% had a combination of antibiotics ampicillin, sulbactam and gentamicin, 93% died of sepsis. The conclusion of this study is gastroschisis patients are predominantly male, young maternal age, primigravida, term baby, have a low birth weight, staged closure performed to almost all patients. The most common antibiotic given was ampicillin sulbactam combined with gentamicin. The mortality rate is 100% with sepsis as the main causes of mortality, mostly cared for less than three days before died and most have a length of survival less than five days. Recommended for women at high risk of doing the ANC to a place with more comprehensive facilities, in addition, it is necessary to do blood cultures in all patients with gastroschisis complicated by sepsis.

Biography:

Yohko Maki is a researcher at the National Center for Geriatrics and Gerontology (NCGG) and she also currently serves as Chief of Education and Innovation Center at NCGG. Her research is focused on dementia care, dementia rehabilitation, and social participation of persons with dementia to improve social quality of life of persons with dementia and their family members. 

Abstract:

Dementia is a life-changing disease, especially for aspects such as relationships with others. As dementia affects independence, maintaining social relationships should be one of the critical issues in dementia care. Thus, for people living with dementia, such support is necessary in order to enhance the quality of their social life within the context of their interpersonal relationships with others, especially family members. Persons with dementia and their family members are inevitably faced with various challenges in their daily life. As the most causative disease of dementia is progressive in nature, living with dementia is a continuous process of coping with such challenges. If they fail to cope with these difficulties in daily living well, their caregiving burdens will increase. Thus, it is necessary to provide them with support to help them manage such challenges, but the most important thing is to ensure that persons with dementia themselves maintain the will to make their lives more meaningful and enjoyable under such circumstances while receiving support and assistance from others. Discussions related to dementia care tend to focus on how to provide care for persons with dementia, but they are not mere care-recipients, and they should be able to decide how to live autonomously. Even in the advanced stages, persons with dementia are capable enough to maintain the will to live well with dementia. If persons with dementia and their family members succeed in feeling and expressing thankfulness for their current relationships, they may find meaning in living with dementia.

Biography:

Wahyu Purnama Putra is a General Surgery Resident at Saiful Anwar Malang Hospital. He was trained and registered as a General Practitioner from Brawijaya University in 2014. He currently is the Director of Hayunanto Medical Center Hospital in Malang, Indonesia. His experiences included following training in ATLS, advance surgery skill and other courses in the field of emergency medicine and traumatology.

Abstract:

Background: Penetrating traumatic injury remains one of the most devastating and lethal forms of trauma. Prognosis is generally poor and, for those who survive long enough to make it to the hospital, the management of penetrating brain Injury presents complex challenges to medical and surgical providers in the civilian sector. A prognosis in such cases is based mainly on an initial score on the Glasgow Coma Scale (GCS). According to the literature, the mortality rate among patients with initial GCS ranging from 3 to 5 points is very high; up to 98.5%. The treatment in an ICU which is focused on decreasing the risk of secondary brain damage can significantly improves the prognosis and final outcome.

Case Description: A male of 40-year-old came up with low level of unconsciousness after traffic accident bus versus truck with iron penetration in the right eye to left head. Patient with spontaneous and symmetrical breathing, unstable hemodynamic with GCS 123, isochoric pupils and positive light reflex in the left eye, corneal reflex (-/+), local status of this patient is penetration of iron in right orbital region to left parietal, length: 30 cm and diameter 3 cm.

Conclusion: We choose trepanation decompression evacuation because in general, the results of trepanation in this case are excellent and show good progress from clinical pattern.

Discussion: Early recognition and management penetrating brain injury is essential to ensure an optimal outcome. According to the literature, the majority of PBI results from attempted suicides, assaults and accidents. Evaluate corpal, size and mechanism of injury is a key to early diagnose for the patient. During operation, care must be taken not to produce any rocking movement which may be transmitted to the tip of the instrument and removal should retrace the original trajectory of the corpal. The fundamental principles of surgical management include the prevention of early or late infection, thorough debridement of necrotic tissue and hematoma, removal of all accessible bone fragments and foreign body and meticulous closure to prevent cerebrospinal fluid fistula. Operative delay for greater than 48 hours from the time of injury dramatically increases the incidence of infection from 4.6 to 36.5%. The current case is illustrative of the importance of early surgical exploration to avoid delayed infectious, vascular and epileptic complications. The two most common complications of these injuries are infection and secondary hemorrhage.

Biography:

Erica Dean is an Australian General Surgical Trainee at Shoalhaven District Memorial Hospital, Australia.

Abstract:

Ischiorectal abscess represents less than 15% of all anorectal disease and affects men three times more than women, possibly owing to the immunosuppressive effects of male sex steroids. It is traditionally treated by incision and drainage. We present the case of a 40-year-old man with a severe ischiorectal abscess, which we treated using a novel surgical technique. He presented with a one-week history of severe perianal pain, fever and tachycardia. On examination, his perineum was diffusely oedematous, erythematous and tender to palpate. He was a heavy smoker, however otherwise fit and well with no history of diabetes mellitus or other immunosuppression, computed tomography scan of the pelvis demonstrated infralevator horseshoe abscess with gas locules. He underwent emergency operation. Incisions were made bilaterally over both arms of the abscess (modified Hanley procedure) a corrugated drain was passed to bridge the horseshoe and a silicon vessel loop seton was placed through the associated fistula-in-ano at the 7 O’ clock position. He was taken back to theatre on day 7 for repeat washout and removal of the drain. At the second operation, two stab incisions were made adjacent to the original incisions through which two silicon vessel loop drains were passed and secured with silk. He had minimal postoperative pain and was discharged home on the third day. The vessel loops were painlessly removed, two at a time at 2 and 6 weeks. At the time of writing there was no recurrence. The Loop and Drain Technique (LDT) was first described in Australia by Gaszynskia, et al. as a safe and effective treatment for subcutaneous abscess. Today it is used around the world and in our hospital is a routine surgical treatment of subcutaneous perianal and pilonidal abscesses, as well as deeply contaminated lacerations. Our case demonstrates that LDT is a safe surgical technique for the treatment of ischiorectal abscess, which should be performed in an operating theatre where optimal lighting, positioning and washout can be achieved. It offers increased comfort and convenience for the patient, negating the need for repeat packing.

Biography:

Novia Nastiti has completed her primary medical qualification at Semmelweis University in Budapest, Hungary. She has completed her Master of Science in Medicine as well as her MD on the importance of the sentinel lymph node biopsy with a particular focus on breast surgery. She is currently an FY2 trainee in the NHS.

Abstract:

Introduction: Littre hernia is defined as a hernia in which hernia sac contains Meckel’s diverticulum. It presented with an irreducible mass in right femoral site diagnose preoperatively as an incarcerated femoral hernia.

Case Study: This case study of a femoral hernia with incarcerated Meckel’s diverticulum happened to 30-year-old male. Case which has been carried us, through tough explaining in critical care condition. The diverticulum was resected using wedge resection technique. Meckel’s diverticulum is an intestinal diverticulum which arises due to the failure of omphalomesenteric duct obliteration in the fifth week of fetal development. The incidence of this disorder is between 2-3% and is the most common congenital anomaly in the gastrointestinal tract. Management of liter hernias must be done surgically. Littre hernia with incarcerated Meckel’s diverticulum in femoral hernia. In this case, the treatment was wedge resection surgery followed by repair of the femoral hernia defect.

Biography:

Kristoff Armand E Tan is a young Vascular Surgical Registrar in Australia with an interest in infrainguinal bypass surgery, surgical education and training.

Abstract:

Aim: To determine the predictive value of the hernia score in an external dataset and identify other factors associated with the development of VIH (Ventral Incisional Hernia).

Method: This is a retrospective observational study of patients who underwent an abdominal surgery for gastrointestinal malignancy in a tertiary care hospital from 2013-2017. The overall accuracy and predictive value of the hernia score was computed. To increase predictive value, other preoperative and intraoperative variables associated with the development of VIH were identified.

Result: A total of 447 patients were included in this study and 73 (16.3%) of these patients were diagnosed radiographically to have VIH following an abdominal surgery. The hernia score was found to have an overall accuracy of 48.16% and a positive predictive value of 36.6%. Three other perioperative variables, smoking, (odds ratio-13.43), diabetes mellitus (odds ratio-15.86), previous surgery (odds ratio-9.74) were found to be predictive for the occurrence of VIH.

Conclusion: The overall accuracy of the hernia score in predicting VIH in patients who underwent an abdominal operation for gastrointestinal carcinoma is poor smoking, diabetes mellitus and previous surgery are significant predictors for developing VIH and may be included increase predictive value of the hernia score.

Biography:

Shenglong Ding, a graduate student in orthopedics at Shanghai Medical College, Fudan University, has his expertise in Intervertebral disc degeneration and biomaterials field. He has published articles entitled Salt-assisted toughening of protein hydrogel with controlled degradation for bone regeneration and " Bombyx mori Silk Based Materials with Implication in Skin Repair: Sericin versus Regenerated Silk Fibroin in the field of materials.

Abstract:

Aim: The present study aims to evaluate the short-term clinical effects and complications of modified three-screw fixation and conventional two-screw fixation for treating anterior pelvic ring fractures.

Methods: A retrospective study of 51 patients with type B fractures was performed. 25 patients (modified group) were treated with modified three-screw fixation and the other 26 patients (conventional group) with conventional two-screw fixation. Outcome measures included operation time, intraoperative blood loss, hospital stays, postoperative complications and the Majeed score at postoperatively 2 months, 3 months, 1 year and the time of implant removal.

Results: The mean operative times and mean blood loss for modified three-screw fixation versus conventional two-screw fixation bilateral were 54.8±10.7 min versus 32.3±9.9 min, and 153.3 mL versus 550.0 mL(p<0.001), respectively. However, the Majeed score was better in modified group at postoperatively 2 months (75.6±9.5 vs 69.7±8.3, P=0.008) and 3 months (80.3±10.7 vs. 75.1±11.9, P=0.014). No statistical difference between two groups at the time of implant removal (82.1±9.3 vs 80.9±8.8, P=0.272) and postoperatively 1 year (83.5±7.8 vs 82.6±8.2, P=0.723). No patients experienced surgical wound infection, deep vein thrombosis, delayed union or nonunion, implant loosening or rupture. 1 patient complained of tardive unilateral thigh pain at postoperatively 4 months in conventional group.

Conclusions: Both modified three-screw fixation and conventional two-screw fixation could ultimately afford satisfactory clinical and radiological outcomes with less complication for anterior pelvic ring fractures. The modified three-screw fixation might have better biomechanical strength and faster pelvic rehabilitation.

Biography:

Alexander Mimery has completed his primary medical qualification at Semmelweis University in Budapest, Hungary. He has completed Master of Science in Medicine as well as his MD on the importance of the sentinel lymph node biopsy with a particular focus on breast surgery.

Abstract:

Introduction: Daytime emergency operating lists have been demonstrated to reduce surgery performed after hours.

Method: A retrospective review of Laparoscopic Cholecystectomies (LC) and Laparoscopic Appendicectomies (LA) between September 2013-September 2017 at a Brisbane tertiary hospital before and after the introduction of a daytime Emergency Operating List (EOL) in February 2016. Daytime was defined as 08:00-16:59, evening was defined as 17:00-21:59 and overnight was defined as 22:00-07:59.

Result: A total of 1392 laparoscopic cholecystectomies and 1201 laparoscopic appendicectomies were performed during the study period. There were 649 emergency appendicectomies in the pre-EOL period of which 281 cases (43%) were performed in the evening and 9 cases (1.4%) were performed overnight. In the post-EOL period there were 517 emergency appendicectomies of which 215 cases (42%) were done in the evening and 9 cases (2%) were performed overnight. There were 67 emergency cholecystectomies in the pre-EOL period of which 11 cases (16%) were performed in the evening and no cases were performed overnight. In the post-EOL period there were 106 emergency cholecystectomies of which 12 cases (11%) were done in the evening and no cases were performed overnight. The introduction of the EOL was able to increase the monthly provision of emergency LC by a factor of 2.4 (2.28 cases/month pre EOL, 5.52 cases/month post EOL).

Conclusion: The introduction of the emergency operating list did not reduce after hours operating in our facility but enabled us to perform more emergency cholecystectomies in the daytime.

Biography:

Sovpel Igor Vladimirovich has been working at the G.V. Bondar Republican Cancer Center in Donetsk, Ukraine.

Abstract:

Background & Aim: Hiatal hernia is a common disorder, that in most cases complicated by gastroesophageal reflux disease. The main objectives of the surgical treatment of symptomatic hiatus hernia are the reduction of symptoms, improvement in quality of life and reduce the risk of life-threatening complications. Recently, the procedure is not standardized, and most reports contain small cohorts of patients and short follow-up periods. The purpose of this study is to analyze short-term and long-term results of surgical treatment of patients with hiatal hernia complicated by gastroesophageal reflux disease.

Method: A retrospective analysis of the short-term and long-term results of treatment of 171 patients suffering hiatal hernia complicated by gastroesophageal reflux disease was performed. All patients were underwent laparoscopic hiatal hernia repair supplemented by Nissen fundoplication-109 patients and Toupet fundoplication-62 patients.

Result: The duration of hospital stay was 7.2±1.6 days. The duration of surgical intervention was 144±17.8 min. Mild functional dysphagia was noted in 30 (17.5%) patients. Persistent long-term dysphagia in the late postoperative period was observed in 10 (5.8%) patients. The recurrences of hiatal hernia or GERD were noted in 32 (18.7%) patients in 5 years after surgery. The total GERD-HRQL questionnaire score in 5 years after surgery was 6.7±2.9 compared to the baseline score of 31.2±6.3 before the surgery. 121 (70.8%) patients reported satisfaction after surgery and 26 (15.2%) were neutral.

Conclusion: Positive functional results after surgical treatment were noted in 86% of patients. The high frequency of dissatisfactory results in the long-term period requires a more depth analysis in order to find the causes and possible ways to improve the results of surgical treatment of patients with this pathology.

Biography:

Jayme Natasha K Paggao has completed her Bachelor of Arts in Social Sciences, major in Social Anthropology and minor in Political Science from the University of the Philippines, Baguio in 2009. She has completed her Medical degree from The University of the East Ramon Magsaysay Memorial Medical Center in 2013. She is currently a 5^th year Residency Trainee at the General Surgery Department in the same institution.

Abstract:

Background & Aim: Laparoscopic Cholecystectomy (LC) has become the gold standard in the management of symptomatic gall bladder disease. Although it has been shown to be safe and effective, several factors cause difficulty to the operator and may increase operative time and complication rate. However, there is no established scoring system to predict the difficulty of LC in the preoperative period. The study aims to apply a scoring system that can be used pre-operatively to determine the degree of difficulty of a laparoscopic cholecystectomy procedure in the general surgery training program.

Method: There were 113 laparoscopic cholecystectomy cases performed by general surgery residents in 4 years. 8 parameters were collected based on pre-operative data, physical exam, and sonographic findings, with a maximum score of 15. A score 0-5 predicted easy, 6-10 difficult and 11-15 very difficult. Intraoperative score was based on length of procedure, complications and conversion to open procedure.

Result: 2 risk factors: age >50 years (p=0.032) and palpable gall bladder (p=0.014) are found to be statistically significant in predicting difficult LC.

Conclusion: The pre-operative scoring system is reliable with 63% sensitivity in predicting difficult LC procedure.

Biography:

Louise van der Does Paul MacKoul is a young Vascular Surgical Registrar in United States with an interest in infrainguinal bypass surgery, surgical education and training. 

Abstract:

Aim: To compare the risk of complete Vaginal Cuff Dehiscence (VCD) within the first 90 days of hysterectomy using absorbable versus non-absorbable sutures for vaginal cuff closure.

Method: IRB approved, retrospective chart review of patients undergoing laparoscopic hysterectomy for benign disease between October 2013 and April 2018 by two gynecological surgical specialists in an ambulatory surgery center in suburban Maryland, USA. Trans-vaginal cuff closure was performed using either absorbable (Vicryl) or non-absorbable (Ethibond) sutures. Non-absorbable sutures were surgically removed at 90 days post-op.

Result: Non-absorbable n=574; absorbable n=881. No statistically significant difference in age, race, weight, BMI, parity, uterine weight, number of previous abdominal surgeries, or number of comorbidities between the non-absorbable and absorbable groups. We defined vaginal cuff dehiscence as complete separation of the vaginal cuff with or without abdominal or pelvic organ evisceration through the opening. At 90 days, 0 (0.0%) patients in the non-absorbable and 11 (1.2%) in the absorbable group had spontaneous complete cuff separation that required repair (P=0.004). The mean time between the initial hysterectomy and VCD in the non-absorbable group was 72 days.

Conclusion: Our data suggest that using a stronger, non-absorbable suture may be an effective approach to prevent spontaneous and complete vaginal cuff dehiscence in an uncontrolled setting. The benefits of a non-absorbable suture should be weighed against the inconvenience, but low risk associated with removal of sutures in a controlled setting. Non-absorbable sutures should be further explored as a mechanism to prevent complete VCD.

Biography:

Ralene Sim is currently pursuing her studies as a Medical student at National University of Singapore. Her interest is in head and neck research.

Abstract:

Background & Aim: Regional failure in Nasopharyngeal Carcinoma (NPC) is managed by salvage treatment in the form of neck dissection. Radical Neck Dissection (RND) is preferred over Modified Radical Neck Dissection (MRND), since it is traditionally believed to offer better long-term disease control. However, with the advent of more advanced imaging modalities like high-resolution magnetic resonance imaging, computed tomography and positron emission tomography-CT scans, earlier detection is achieved. Additionally, concurrent chemotherapy also contributes to reduced tumor burden. Hence, there may be a lesser need for a RND and a greater role for MRND. With this retrospective study, the primary aim is to ascertain whether MRND, as opposed to RND, has similar outcomes and hence, whether there would be more grounds to offer a less aggressive procedure to achieve lower patient morbidity.

Method: This is a retrospective study of 66 NPC patients treated at Singapore General Hospital in between 1994 to 2016 for histologically proven regional recurrence of which 41 patients underwent RND and 25 who underwent MRND, based on surgeon preference. The type of ND performed, primary treatment mode, adjuvant treatment and pattern of recurrence was reviewed. Overall Survival (OS) was calculated using Kaplan-Meier estimate and compared.

Result: Overall, the disease parameters such as nodal involvement and extra nodal extension were comparable between the two groups. Comparing MRND and RND, the median (IQR) OS is 1.76 (0.58 to 3.49) and 2.41 (0.78 to 4.11), respectively. However, the p-value found is 0.5301 and hence not statistically significant.

Conclusion: RND is more aggressive and has been associated with greater morbidity. Hence, with similar outcomes, MRND could be an alternative salvage procedure for regional failure in selected NPC patients, allowing similar salvage rates with lesser mortality and morbidity.

Biography:

Unnati M Shah has completed MS from Grants Medical College, Bombay University, India and Fellowship in MAS from Sir Gangaram Hospital, New Delhi. He is an Associate Consultant in the Department of General and Laparoscopic Surgery. He has published many papers in reputed journals including index journals and an Assistant Professor in GRIPMER, the academic wing of the hospital.

Abstract:

Pneumatic colon injury is a rare entity resulting from high pressure blow to perineum, industrial accident and perineal blasting with compressed air had been commonly reported in adult and results in colon injury either with or without perforation. Spraying of the perianal with excessive pneumatic force of greater than the resting anal pressure and high air flow rate causes multiple site colon injury and tension pneumoperitoneum due to colon perforation. Air from pneumatic tools produces column of air at pressure of 3.5-8.8 kg/cm² and pressure greater than the resting anal pressure of 0.109 kg/cm² force air to enter the colon when the perineum is sprayed. Different degree of colon injury results when airflow is greater than 1.46 L/m and/or intraluminal pressure greater than 0.109 kg/cm². We are presenting a rare case of 26-year-old male who developed sudden onset of tense abdominal distention followed by peritonitis. History revealed that the patient’s perineum was sprayed, using high pressure industrial device. Patient came to emergency department and was managed as per protocol of acute abdomen. X-ray abdomen showed air under diaphragm, so patient was taken for emergency exploratory laparotomy revealed a tension pneumoperitoneum, multiple site of ecchymosis and serosal tear of the colon and perforation of sigmoid colon. Primary closure of perforation with omentopexy followed by temporary loop colostomy was done. Postoperatively patient was shifted to ward and IV antibiotics were given. Patients with acute abdominal pain of unknown origin should be checked for history of trauma and occupational history using compressed air.

Biography:

Abdullah Y Naeem has been graduated Msc and MD from Cario university and been working in New Al-Kassr El- Aini French Teaching Hospital.

Abstract:

Background: Standard reverse island sural artery flap is the most common usage for distal third defects of the leg. However, many authors reported 36% complication rate mainly partial or complete flap loss that is attributed to venous congestion. Delayed reverse sural artery flap in two stages with skin pedicle technique is reliable and less complicated. In this study was compare between the results of both techniques. 

Method: The study included 40 patients presented to Al-Wahda University Hospital and 48 Military Hospital, after trauma of lower leg with complete loss of soft tissue and exposure of underlying structures, within periods Oct 2013 to May 2017. The patients were 30 male and 10 females, their age ranged between 15-60 years old. Reverse island sural artery flap was used in 20 patients, while delayed sural artery flap was used in 20 patients too. The results of both techniques were compared. 

Result: In our study the standard reverse island sural artery flap is good option for reconstruction of lower leg, ankle and malleoli defect, which is performed in 20 patients, the partial necrosis occur in 20% patients and three cases with flap failure, the venous congestion occur in 35% of patients In this study, we performed reconstruction of the lower leg, heel, and malleoli in another 20 patients by delayed reverse sural artery flap with skin pedicle technique, the flap necrosis occur only in one case and partial flap necrosis occur in two cases only, in comparison with standard technique of reverse island sural artery flap, the venous congestion occur only in four patients 20%, two cases recovering the congestion by leg elevation and improving the patients hydration and two cases of venous congestion progressive to partial flap necrosis. Partial necrosis occurs in two cases, complete flap necrosis occurs in one case and 95% of patient’s satisfaction in discharge. 

Conclusion: The delayed reverse sural artery flap with skin pedicle is very important to avoid of venous congestion and flap failure, especially in old patients, DM and in patients with peripheral vascular diseases. The goal of our study was achieved and the patients improved functionally and attained their routine activity. By this technique and modification, make the delayed sural artery flap the first choice in reconstruction of the lower third defect of leg, heel and ankle and is less postoperative venous congestion and flap failure. Delayed sural artery flap in two stages with skin pedicle technique is convenience and less complication particularly for old patients with diabetes mellitus and peripheral limb ischemia or venous insufficiency.

Biography:

Djordje Dzokic is in the midst of completing his MD from the University of Ottawa after studying Physiology at McGill University. He is a Student Researcher at the University of Ottawa Heart, specializing in General and Cardiac Surgery. He is the President of Medical Student Society at the University of Ottawa.

Abstract:

Aim: In this work, we aim to present the clinical applications and related literature for the algorithm of the technique which will be applied, according to the location of the defect, in choosing the surgery treatment method.

Method: A review of 177 post excisional periorbital defect reconstructions was performed in the last five years. In this way, 177 patients were obtained and evaluated in terms of age, gender, cause, location and size of defect, surgery treatment methods applied, form of anesthesia and the different flap alternatives applied.

Result: The age distribution ranged between 11 and 93 years with 80 (45.2%) of the patients being women and 97 (54.8%) of the patients being men. The overall average patient age was 58.50 years, with the average age of the men being 56.78 and of women being 60.22 years. Flaps from the cheek in five patients (8%), V-Y flaps from the upper eyelid in five patients (8%), lid switch flaps (for upper eyelid defects) in two patients (3.3%), Tripier flaps (for lower eyelid defects) in five patients (8%), Fricke flaps in three patients (4.9%) (two patients for upper, one patient for lower eyelid defects), superficial temporal artery frontal branch based island flaps in four patients (6.5%) (2 for lower, 2 for upper eyelid defects), temporoparietal fascia flap in one patient (1.6%) for an upper eyelid defect and a nasolabial flap was used in two patients (3.3%) for lower eyelid defects. In nine patients (14.5%) reconstruction using local flaps (Limberg, rotation and transposition) was used. With respect to postoperative complications, there were a total of 6 (3.38%) patients observed with venous congestion. In 11 (6.21%) patients ectropion developed, flap loss was observed due to a circulatory disorder.

Conclusion: The periorbital region requires different and special care in terms of reconstruction, because of its complex anatomy and important structures. This area was divided into five anatomical regions by Spinelli in order to promote the localization of defects and reconstruction. These regions include: Zone-1: Upper eyelid; Zone-2: Lower eyelid; Zone-3: Medial canthal region; Zone-4: Lateral canthal region; Zone-5: Other facial regions related to these regions. The aim of reconstruction is to repair the defect suitable to normal physiological and anatomical values. As a result, before the surgical treatments in this difficult anatomical region, the defect width and anatomical localization must be evaluated. The most suitable reconstruction method must be identified, using an evaluation of the algorithm and the required functional and esthetical results can be obtained with intraoperative flexible behavior and a change of method, when necessary.