Lower Lid Orbicularis Oculi Myocutaneous Transposition Flap for Orbital Radiation Induced Scars

Kim, Dong Chul; Lee, Hee Young; Jung, Dong Ju; Lee, Ryun; Kim, Jae Hee; Kim, Tae Yeon; Lee, Se Il

Abstract

PURPOSE
Reconstruction for post-radiation scar on periorbital area including upper eyelid takes consider of eyelid function and cosmetic results. It is a challenging procedure to reconstruct the severe radiation induced scars deformities on face around the orbital area in terms of its complicated anatomy and restoration of cosmetic social function. The authors report a reconstruction case of radiation induced severe facial deformities with scars including upper lid and periorbital area using evidence based plastic surgical techniques such as newly designed lower lid orbicularis oculi myocutaneous transposition flap, lateral canthopexy, skin graft, composite graft, fat graft, acellular dermal matrix graft, Z-plasty focusing on cosmetic and functional result.
METHODS
A 18 year-old female patient had right upper facial deformities caused by radiation induced wide scars around the right periorbital, upper lid and temporal area after treatment for hemangioma at age of 1. She also showed right facial palsy on forehead, and hypoplasia of left ala nasi. The patient suffered from skin atrophy, wide scar formation, scar contractures on right periorbital area, severe lagophthalmos on right eye, right frontal facial palsy, and small hypoplastic left ala nasi. At the first operation, release of scars and full thickness skin graft, reposition of asymmetric right eyebrow caused by facial palsy using Z-plasty, correction of temporal depression using acellular dermal matrix (AlloDerm(R)) graft, and auricular composite graft for left ala nasi reconstruction were performed. And after 4 months follow-up, the second operations were performed including lower orbicularis oculi muscle transposition flap for upper lid lagophthalmos, lateral canthopexy, and fat graft.
RESULTS
Lower lid orbicularis oculi muscle transposition flap and all grafts were successfully survived. After 3 weeks follow-up, she showed good looking facial appearance and facial symmetry, and there were no complications.
CONCLUSION
For post-radiation facial scar reconstruction, it showed a better cosmetic outcome using flap transfer rather than skin graft. The newly designed lower eyelid orbicularis oculi muscle transposition flap, canthopexy, fat graft give a good result for reconstruction of radiation induced scars of upper eyelid and periorbital deformities.