Monday, February 21, 2011

Challenging Eyelid Cases: Contracture of the Upper Eyelid from Shingles

This unfortunate girl had a left upper eyelid contracture from shingles. She was unable to shut her eye at sleep and without treatment she would eventually lose the right vision. To correct the contracture, it was important to remove the contracture. This could be achieved in two ways: skin graft or skin flaps using z-plasty to lengthen the skin. Although skin graft is the easier technique, the result maynot be good as the graft may not match the colour of the eyelid and additionally prolonged patching would be required to avoid eyelid movement which can result in graft failure. Therefore, I decided to perform skin flaps using a combination of z-plasty and glabellar flap (skin from the forehead).

Left upper eyelid contracture with corneal scarring.

Markings done before performing the surgery.
The forehead skin was used to replace the skin shortage.

The upper eyelid was kept on traction to facilitate surgery.

The flaps were created along the marked lines.

The forehead skin was trimmed to make it thinner.

The skin flaps were openedand the subcutaneous tissues
that give rise to contracture (arrows) were excised.

Additional cuts were needed to completely release
the contracture.

The scar tissues should be excised as much as possible
to release the contracture.

The upper and lower eyelids were sutured together to immobilize
 the upper eyelid so that the flaps have a higher chance of success.

The forehead skin was rotated 90 degrees to replace the skin shortage.

Suturing of the skin flaps.

At the end of the operation.

4 days after the surgery, the contracture appear to be
corrected but it is important to keep the eyelids closed
to avoid early contracture of the flap.

I will report the patient's progress in future blog.

No comments:

Post a Comment