E.S. Milyudin - Dr.Sc. (Med.), Head of Department, Samara Region Clinical Ophthalmological Hospital n.a. T.I. Eroshevsky; Deputy Director, Research Institute of Eye Diseases SamGMU (Samara)
A.V. Yudakov - Ophthalmologist, Samara Region Clinical Ophthalmological Hospital n.a. T.I. Eroshevsky
Surgery treatment is becoming more aggressive in modern stage development of oncology. There are a lot of radical surge-ries, so it helps us to improve results of treatment. Cosmetic defects depend on degrees of radicalism in surgery. Loss of periorbital tissues is especially actual. If size of full-thickness eyelid defect isn’t more than one third of the length, we cover it by transposition full-thickness flap from unilateral eyelid. Base problem in covering of full-thickness eyelid defect more than one third of the length is necessity of restoring skin, tarsal plate and creating adequate conjunctive fornix. Skin graft-ing is treatment of choice in restoring skin restoring. Covering defect of tarsal plate is more difficult. Some authors are using cadaveric cartilage. Prevalence has method of covering tarsal plate’s defect by biomaterial «Alloplant», it is cuting to required size. Most popular material is an autologous cartilage from the auricle. We have researched results of treatment in 9 patients with eyelids neoplasm. All patients had full-thickness resection more than half length of eyelid. Plastic was per-formed by a skin-cartilaginous flap from the back of the auricle with the purpose of restoring the tissue defect. We had made cytology and histology in all cases of eyelid neoplasm. We achieved a good functional result in all cases of surgical treatment by our method. Skin flap was adapted, tarsal plate was provided sufficient density and shape of the eyelid, conjunctive fornix was deep enough, the surface of the conjunctiva was lined with a conjunctive epithelium. In long-term postoperative period tumor recurrence was observed in 32% of cases, which is explained by the results of histology. Excision of the tumor is not within the limits of healthy tissue. Unfortunately, using this method of surgical treatment eyelid neoplasms isn’t restoring the muscle layer, which it causes atony, especially of the lower eyelid. Another significant drawback of this method is the formation of a sufficiently pronounced cosmetic defect in the auricle. The advantage of this method is less traumatic. Almost all authors agree on the advantages of using cartilage of the auricle as a transplant for reconstructing the defects of the tarsal plate of the eyelid. First of all, it is simple and convenient for take away, it is easy to model by thickness and curvature. Secondly, there is no need to form an interlayer between the skin flap and the cartilaginous plate, the tissue was carried out by a single complex. The main advantage of this method is the simultaneous restoration of the conjunctive surface of the eyelid by the silicone-dried plasticized amniotic membrane «Fleksamer». The replacement of the «Fleksamer» biomaterial ends on the 10th-13th day of the postoperative period by the formation of a conjunctival tissue, it is densely attaching to the tarsal plate and forming a single whole with the surrounding healthy conjunctiva. Using of silicone-dried plasticized amniotic membrane «Fleksamer» in the surgical treatment of eyelids neoplasms allows to achieve: reliable anatomical effect during the operation, shortening postoperative treatment, and alleviate the postoperative period.
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