Journal List > J Korean Ophthalmol Soc > v.50(7) > 1008318

Jang and Chang: Upper Eyelid Reconstruction Using the Medpor® Sheet and Median Forehead Flap

Abstract

Purpose

To report the upper eyelid reconstruction with median forehead flap and Medpor® sheet implant following full-thickness eyelid defect resulting from tumor resection.

Case summary

A 65-year-old woman was examined at our hospital for a recurrent mass on the right upper eyelid. A wide tumor excision with a 3 mm margin and an eyelid reconstruction procedure were performed after a frozen section biopsy revealed a malignancy. The full-thickness eyelid defect was reconstructed with a median forehead flap as a substitute for skin and muscle and a Medpor® sheet substituted for tarsal plate was sutured with a lower conjunctiva flap for posterior lamella. The histopathology diagnosis of the lesion showed a well-differentiated squamous cell carcinoma. The lower conjunctiva was separated at 2 weeks after surgery, and then the median forehead flap detached from the upper eyelid skin at 8 weeks after surgery. One year postoperatively, there was no evidence of a wound infection and an exposure of the Medpor® sheet. The eyelid had a good cosmetic contour and the movement of the eyelid during blinking was natural.

Conclusions

The use of a Medpor® sheet as a substitute for a tarsal plate in reconstructive procedures of the upper eyelid defect shows cosmetic and functional success.

References

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Figure 1.
Preoperative photography. (A-C) An ovoid shaped nodular mass is located in the right upper eyelid. (D) The tumor is extended into the upper eyelid margin and the palpebral conjunctiva.
jkos-50-1105f1.tif
Figure 2.
Intraoperative photography. (A) About 18×12 mm-sized full thickness eyelid defect occurred after wide tumor resection. (B) A lower conjunctival advancement flap (white arrow) was made by starting an incision 4 mm from lid margin and dissection of a conjunctiva from lower tarsal plate. (C) The conjunctival flap was advanced and sutured at upper lid defect. (D) A Medpor® sheet was used as a substitute for the tarsal plate. (E) An anterior lamellar graft was harvested from the median forehead and sutured without tension on the pedicle flap. (F) An upper eyelid reconstruction was completed using forehead median flap, Medpor® sheet and lower conjunctival flap.
jkos-50-1105f2.tif
Figure 3.
Photomicrographs of a section of tumor. (A) Microscopic findings of the upper eyelid show irregular clusters of anaplastic squamoid tumor cells infiltrating into the deep dermis (hematoxylin-eosin, ×100). (B) High power view of tumor mass shows keratinization of single cells (arrow) and intercellular bridge (thick arrow) in squamoid tumor cell sheets (hematoxylin-eosin, ×400).
jkos-50-1105f3.tif
Figure 4.
At 1 year postoperative photography. (A) An upper eyelid contour seems like normal feature after separation of median forehead flap. (B) There is a V-shaped mark on the glabella due to using median forehead flap in reconstructive procedure of the upper eyelid.
jkos-50-1105f4.tif
Figure 5.
Postoperative magnetic resonance image. A Medpor® sheet (thick arrow) is well placed in the right upper eyelid (A, T1-weighted axial thin fat saturation image with a Gadolinium enhancement, B, T1-weighted sagittal thin fat saturation image with a Gadolinium enhancement).
jkos-50-1105f5.tif
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