J Korean Ophthalmol Soc.  2009 Jul;50(7):1098-1104. 10.3341/jkos.2009.50.7.1098.

Effects of Medpor(R) Sheet as Substitute for Tarsus in Eyelid Reconstruction

• Yoon HJ
• Kim SJ
• Yoon SW
• Yoon YS

• KMID: 2212501
• DOI: http://doi.org/10.3341/jkos.2009.50.7.1098

Abstract

PURPOSE
To report a simple surgical technique for rebuilding the palpebral tarsal plate using a Medpor(R) sheet. The formation of a palpebral tarsal plate is very important in the reconstruction of the eyelid. Transplantation of cartilaginous tissue is often necessary to create the palpebral tarsal plate. However obtaining enough cartilaginous tissue is difficult. CASE SUMMARY: Eyelid reconstruction and surgical resection of each lesion was attempted on two patients clinically diagnosed with basal cell carcinoma and sebaceous gland carcinoma between August, 2006 and November, 2007. Reconstruction was performed using a modified Cutler-Beard method or the sebaceous gland carcinoma that occurred in the upper eyelid, and a modified Tenzel semicircular rotational flap procedure was used or the basal cell carcinoma that occurred in the lower eyelid. For the reconstruction of tarsus, 0.45 mm Medpor(R) sheet was used. Complications, such as shortage of eyelid movement, dragging of eyelid or unstable eyelid margin, did not occur after the operations in either subject. In the case of the upper eyelid reconstruction, the eyelid became stiff at the early stage, but the condition improved after 6 months. CONCLUSIONS: The reconstruction of the palpebral tarsal plate using a Medpor(R) sheet is considered an effective and safe technique for the reconstruction of an eyelid.

Keyword

Medpor(R) sheet; Palpebral tarsal plate; Reconstruction of the eyelid

MeSH Terms

Animals
Ankle
Carcinoma, Basal Cell
Eyelids
Humans
Sebaceous Glands
Transplants

Figure

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  Figure 1. Medpor® Sheet (Dimension 16×27×0.45 mm, uncoated) Sheet.

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  Figure 2. (A) Full-thinkness upper eyelid defect was created after the resection of sebaceous cell carcinoma. (B) The full-thinkness lower eyelid flap was made. (C) The skin-muscle flap and conjunctival layer was created and tagged respectively. (D) The advanced lower eyelid conjunctival layer was sutured with the upper eyelid levator muscle and medial, lateral tarsal remnant. (E) The Medpor® Sheet was sutured over the conjunctival layer. (F) The skin-muscle flap was sutured over the conjunctival layer.

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  Figure 3. (A) A patient clinically diagnosed with sebaceouscell carcinoma, upper eyelid reconstruction was attempted along with surgical resection of the lesion. (B) The condition of the eyelid became more natural condition after 24 months.

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  Figure 4. (A) pre-operative design. preoperative appearance of the patient with basal cell carcinoma involving the lateral 1/3 of the left lower eyelid. (B) After the pentagonal resection and frozen-section monitoring of the surgical margins. (C) To begin reconstruct the lower eyelid, a skin and muscle is begun at the lateral canthal angle and is carried superiorly and laterally in a semicircular fashion. (D) The skin and muscle flap is widely dissected. (E,F) The Medpor® Sheet was inserted in the pocket which was formed between the muscle flap and conjunctiva. (G) To prevent implant's exposure, the pocket was sutured with 6-0 Vicryl sutures. (H) The flap was advanced medially. the eyelid was sutured with 6–0 black silk.

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  Figure 5. (A) A patient clinically diagnosed with basal cell carcinoma, lower eyelid reconstruction was attempted along with surgical resection of lesion. (B) The condition of the lower eyelid became more natural condition after 11 months. (C) At 11 months, implanted Medpor® Sheet was neither exposed nor dislocated.

Reference

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