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Loss of an upper eyelid can arise through trauma in a local/remote area. This condition in which the eye cannot be closed is severely affected patient’s vision with unavailable treatment. The patient should be transferred to tertiary health care level for treatment.
We introduce the simple surgical techniques that can be performed at the second healthcare level under local anesthesia without the need for expensive technical equipment. This is an auto frontal skin grafting-single staged procedure on the course of hospital administration for correction of an upper lid which was cut out off due to trauma.
A 32-year-old male farmer fell while digging. He had suddenly known bleeding from the left eye and severe headache, so he cried for help. The neighbor took him to health station of village. A first aid dressing was applied at the local primary health care center and the patient was admitted to the provincial hospital
When traumatic cutting of the upper eyelid occurs, the levator muscle retracts into the orbital fat although it can be retrieved. Secondary repair of post-traumatic ptosis should be delayed for 6 to 9 months as the condition may be self-limiting.
In this patient with full-thickness defect of the upper lid caused by trauma, the levator muscle was not reconstructed. A forehead skin flap to upper lid was performed to cover the eyeball as soon as possible. This flap derives its blood supply from the superficial temporal artery that travels along the lateral orbital rim and above the brow in that area. The pedicle was big enough to nourish the flap. In the author’s experience, the width of the pedicle should be one-third the length of the flap.
The advantage of this one-stage procedure is that the eyeball is covered as soon as possible, thus preventing the possible sequelae of exposure such as ulceration of the conjunctiva or cornea, endophthalmitis, and rarely, enucleation.
In addition, in a tropical climate, ultraviolet light can cause lens and etinal damage. Ultimately, blindness may result. A disadvantage of this technique is that function of the levator muscle is not restored
This article first published in International Journal of Surgery and Research (IJSR) by SciDoc Publishers
We introduce the simple surgical techniques that can be performed at the second healthcare level under local anesthesia without the need for expensive technical equipment. This is an auto frontal skin grafting-single staged procedure on the course of hospital administration for correction of an upper lid which was cut out off due to trauma.
Surgical Techniques
- An incision was made to create a crescent-shaped forehead skin flap (70 x 20 mm) with a few lines of eyebrow.
- The pedicle was at the lateral level of the eyebrow. This skin flap was used to replace the upper eyelid. The few lines of eyebrow replaced the lost eyelashes.
- The forehead wound beneath the flap was closed with running or interrupted sutures.
- To reconstruct a new upper eyelid, the skin flap was rotated anticlockwise to the remaining left upper lid. Using interrupted sutures the head flap was sutured to the medial canthus, the upper edge of the flap to the residual upper lid. The lower edge of the flap with the few lines of the eyebrow was turned down to become the new eyelid margin using running sutures side-by-side. The pedicle remained and was sufficient to support the skin graft
Case Report
A 32-year-old male farmer fell while digging. He had suddenly known bleeding from the left eye and severe headache, so he cried for help. The neighbor took him to health station of village. A first aid dressing was applied at the local primary health care center and the patient was admitted to the provincial hospital
In our case, because of full thickness loss of the total upper eyelid, Mustarde’s method of repair (pedicle flap from lower lid to upper lid) was not appropriate. Thus, a flap from the forehead was used, one-stage-procedure.
When traumatic cutting of the upper eyelid occurs, the levator muscle retracts into the orbital fat although it can be retrieved. Secondary repair of post-traumatic ptosis should be delayed for 6 to 9 months as the condition may be self-limiting.
In this patient with full-thickness defect of the upper lid caused by trauma, the levator muscle was not reconstructed. A forehead skin flap to upper lid was performed to cover the eyeball as soon as possible. This flap derives its blood supply from the superficial temporal artery that travels along the lateral orbital rim and above the brow in that area. The pedicle was big enough to nourish the flap. In the author’s experience, the width of the pedicle should be one-third the length of the flap.
The advantage of this one-stage procedure is that the eyeball is covered as soon as possible, thus preventing the possible sequelae of exposure such as ulceration of the conjunctiva or cornea, endophthalmitis, and rarely, enucleation.
In addition, in a tropical climate, ultraviolet light can cause lens and etinal damage. Ultimately, blindness may result. A disadvantage of this technique is that function of the levator muscle is not restored
This article first published in International Journal of Surgery and Research (IJSR) by SciDoc Publishers