Surgery

Biography

Biography: Djordje Dzokic

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.