Page 82 - Read Online

tissue. Traumatic injuries of the malar region and lateral coverage which addresses all three defects simultaneously
aspect of the upper and lower eyelids are common while preventing functional deficit and distortion of the
following a fall from the motorcycle, or in cases of adjacent tissue. The ideal reconstruction should avoid
severe facial abrasion following a fall and drag along creating a “trap door” deformity, dog ear formation,
a roadway [Figure 4]. There is a need for soft tissue ectropion, and sideburn displacement. [1]

Various local flaps such as the rotation flap, transposition
flap, advancement flaps, rhomboid flap, bilobed flaps,
and “reading man” flaps can be employed for the
reconstruction of such defects. [2‑6] Most of these flaps
have been described for reconstruction of circular defects
following tumor resection. Although rhomboid, bilobed
and reading man flaps provide soft tissue coverage, they
may result in scar formation secondary to the multiple
a b incisions required for flap execution. The Tenzel flap is
an advancement‑rotation flap in which a semicircular
skin‑muscle flap is fashioned from the skin lateral to the
lateral canthus, and which can be used for both upper
and lower eyelids. [7]
McGregor devised a flap that adds a Z‑plasty to the
Mustarde cheek advancement flap for moderate defects
of the lower eyelid. [7,8] An incision is made lateral to
c
the eyelid, slanted upward gently, and carried into the
Figure 2: (a) Posttraumatic soft tissue defect, right lower eyelid and malar temporal region. A backcut is then made at the temporal
regions; (b) immediate postoperative picture following reconstruction; end of the incision and angled medially approximately
(c) late postoperative lateral view following reconstruction
30°. A Z‑plasty is created, which recruits the vertical laxity
from the lateral periorbital region to correct horizontal
defects of the lower eyelid. However, the same technique
could well be utilized to cover moderate defects in the
malar, as well as the upper eyelid region. Similarly by
introducing certain modifications [Figure 1c] the same flap
could be utilized to reconstruct defects of the eyelids and
malar regions.
a b In our experience, the use of hyperbaric oxygen therapy
may result in a favorable outcome in such injuries. Based
on our clinical experience, a minimum of three sessions
of hyperbaric oxygen therapy contributes to a reduction
in edema, which increases the likelihood of flap survival.
While steroids may contribute to the anti‑edema effect,
they may result in associated immunosuppression. [9]
c
The modified McGregor flap is a useful option in the
Figure 3: (a) Soft tissue defect, malar region and planning of the McGregor reconstruction of defects of the upper and lower eyelids
flap; (b) immediate postoperative picture following reconstruction; (c) late
postoperative lateral view following reconstruction and malar regions. Hyperbaric oxygen therapy, as an
adjuvant to such traumatic facial injuries, will yield better
outcomes.

REFERENCES

1. Mutaf M, Günal E, Temel M. Closure of defects of the malar region. J Craniofac
Surg 2011;22:631‑4.
2. Cecchi R, Fancelli L, Troiano M. The “reading man” flap in facial
reconstruction: report of 12 cases. Dermatol Online J 2012;18:16.
3. Hayano SM, Whipple KM, Korn BS, Kikkawa DO. Principles of periocular
reconstruction following excision of cutaneous malignancy. J Skin Cancer
2012;2012:438502.
4. Saito A, Saito N, Furukawa H, Hayashi T, Oyama A, Funayama E, Minakawa H,
Yamamoto Y. Reconstruction of periorbital defects following malignant tumour
excision: a report of 50 cases. J Plast Reconstr Aesthet Surg 2012;65:665‑70.
5. Yenidunya MO, Demirseren ME, Ceran C. Bilobed flap reconstruction in
Figure 4: Schematic diagram representing soft tissue defect on the right infraorbital skin defects. Plast Reconstr Surg 2007;119:145‑50.
side of the face following a road traffic accident 6. Mutaf M, Günal E, Temel M. A new technique for closure of infraorbital

Plast Aesthet Res || Vol 2 || Issue 2 || Mar 13, 2015 71