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44. Jahrestagung der Deutschen Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen e. V. (DGPRÄC), 18. Jahrestagung der Vereinigung der Deutschen Ästhetisch-Plastischen Chirurgen e. V. (VDÄPC)

12.09. - 14.09.2013, Münster

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The hybrid approach for reconstruction of severely destructed lower eyelid region following injection of commercial grade silicone

Meeting Abstract

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  • presenting/speaker Felix von Spiegel - Städt.Kliniken München GmbH, Klinik f.Plastische Chirurgie u.Handchirurgie, München, Deutschland
  • Sebastian Voigt - Städt.Kliniken München GmbH, Klinik f.Plastische Chirurgie u.Handchirurgie, München, Deutschland
  • Milomir Ninkovic - Städt.Kliniken München GmbH, Klinik f.Plastische Chirurgie u.Handchirurgie, München, Deutschland
  • Sarah Lorenz - Städt.Kliniken München GmbH, Klinik f.Plastische Chirurgie u.Handchirurgie, München, Deutschland

Deutsche Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen. Vereinigung der Deutschen Ästhetisch-Plastischen Chirurgen. 44. Jahrestagung der Deutschen Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen (DGPRÄC), 17. Jahrestagung der Vereinigung der Deutschen Ästhetisch-Plastischen Chirurgen (VDÄPC). Münster, 12.-14.09.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. DocP 31

doi: 10.3205/13dgpraec137, urn:nbn:de:0183-13dgpraec1375

Veröffentlicht: 10. September 2013

© 2013 von Spiegel et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.

Gliederung

Text

Introduction: While in the past century, silicone injections for permanent soft tissue augmentation were popular and widely accepted, their use has become unduly controversial due to severe complications, mainly caused by injection of illegal silicones by unlicensed practitioners.

The delicate local anatomy of the lower eyelid region makes it particularly susceptible for complications following silicone augmentation. These include tissue inflammation with a noticeable tendency for tissue retraction and consecutive cicatricial ectropion leading to lagophthalmus and ocular surface irritation.

Material and Methods: We present a case of a 47 year old patient demonstrating severe lower eyelid destruction with consecutive ectropion after injection of commercial grade silicone in Thailand 5 years prior, leading to chronic granulomatous infections requiring multiple surgical interventions.

Our Hybrid approach included radical debridement with complete elimination of silicone residues, latheral canthopexie, reconstruction of the entire lower eyelid aesthetic unit using a supraclavicular full thickness skin graft and temporary tarsorraphy followed by two sessions of autologous fat graft injections.

Discussion: Firm understanding of lower eyelid anatomy and thourough evaluation of the indiviudual reconstructive requirements are fundamental in selecting the appropriate surgical approach for lower eyelid reconstruction. Our patient presented with nearly complete destruction of the superficial lower eyelid unit including the orbicularis oculi muscle following silicone injection.

In order to meet the functional and aesthetic requirements the operative procedure consisted of meticulous silicone removal, prophylactic lateral drill hole canthopexy followed by reconstruction of the entire lower eyelid unit using a full thickness skin graft and temporary tarsorraphy. Four and six months postoperative we repeatedly performed autologous fat grafting for soft tissue augmentation and prevention of tissue retraction.

While many previous publications mainly focus on individual aspects of lower eyelid reconstruction, we describe a staged reconstructive approach for correction of severly destructed lower eyelid defects with consectutive lower eyelid ectropion.

Conclusion: The hybrid approach has proven to be a viable and aestheticly superior surgical strategy.

Gliederung

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