Superotemporal Skin Transposition to Augment the Repair of Tarsal Ectropion

Theme: Oculoplastic & reconstructive surgery
What: Oculoplastic & reconstructive surgery
Part of: Oculoplastics II: Cutting edge research in oculoplastics! / Oculoplastie II: Recherche de pointe en oculoplastie!
When: 5/31/2024, 02:00 PM - 03:30 PM
Where: Room | Salle 714 A

Abstract

Purpose: Patients with involutional/paralytic tarsal ectropion of the lower lid (TEc) may have residual lid margin eversion or increased recurrence after conventional lateral tarsal strip (LTS) and medical conjunctival spindle procedures. 

Chang et al suggested that for paralytic ectropion, the LTS should be attached using a 10-15 mm long tarsal strip to the outer temporal orbital rim, at a point higher than a conventional LTS. In our augmentation we place the posterior lamella in the conventional position to preserve lid globe apposition, but transpose an inferolateral skin flap into a superotemporal wound bed to improve the results of TEc repair.

Study design:  retrospective

Methods: The retrospective review was approved by our Research Ethics Board. Adults with involutional TEc  tarsal ectropion between 2021 and 2023, and that underwent LTS surgery with anterior lamellar skin transposition between Nov 2021 and Sept 2023 were included in the study.

In our LTS augmentation procedure the excess lateral lower lid skin is not discarded, but fashioned into a flap that is transposed into a 1 cm superotemporal triangular wound bed in a tongue-in-groove fashion with anchoring to the periosteum.

As initial results showed that this skin augmentation markedly improved the lid margin position markedly in patients with TEc compared to senior author’s convetional LTS, it was not felt a control group would be ethical.

Results: 12 cases of TEc in 8 patients who underwent LTS with skin augmentation and medial conjunctival spindle were reviewed. At 2-4 week follow-up, all of the patients had good lid globe apposition with less than 2 mm of residual lid eversion or lid margin erythema.   None of the patients required repeat surgery at 6 month follow-up.

Disadvantages of our flap augmentation compared to conventional LTS included approximately 5 more minutes of operating room time, more ecchymosis in the immediate post-operative period, and more prominent lateral canthal skin scarring at the 2 week mark, which faded over 6 month follow-up. 

 

Conclusions: Patients with TEc and superotemporal skin flap augmentation have less lid margin erythema and post-op ectropion than patients undergoing conventional LTS.The technique is straighforward, but further long-term follow-up is required.

Presenter(s)

Presenting Author: Edsel Ing

Additional Author(s):

Georges Nassrallah, University of Toronto

---