Monday, November 8, 2010

Don't forget to fasten your seat belt!

Before seat belt was made compulsory, eyelids lacerations were common injuries resulting from head collison against the windscreen. As an oculoplastic surgeon, I often get patients referred for reconstruction as a result of poorly reconstructed eyelids from windscreen injuries. These poor patients usually lost their eyelid skins during the laceration and the attending doctor was unable to replace the lost skin.Consequently, the remaining skins were sutured together resulting in eyelid contraction and problem closing the eyes. The treatment is to replace the skin shortage with skin grafts or flaps.

Poorly reconstructed eyelid with skin shortage.
Patient was unable to close eye.
 Reconstructed eyelid using skin from behind the ear.
Patient was able to close the eye fully.

To avoid the problem seen above it is essential to meticulously close the wounds and replace the lost skin when the patient is first seen. If the skin could not be found, the defect should be covered with skin flaps instead of just suturing the remaining skin which is a sure way of causig eyelid contraction. Unfortunatly, most of the primary doctors are not trained to perform reconstructionn in eyelid with large skin defect. The following patient was referred to me recently with a significant eyelid skin defect from windscreen injury. I performed two skin flaps to close the central defets.

Full thickness eyelid skin lost. Although the eye could close
well, when the skin grows back contraction will happen
resulting in problem with lid closure.

Areas of defect was located at the mobile part of the eyelid and
unless the skin is replaced, eyelid movement and closure
will be impaired.

The white line outlined the area of skin defect.

 Diagram showing creation of skin flaps which
were rotated to cover the defects.

Diagram showing the closure of the defect
with rotated flaps.

Closure of the skin defects with flaps.

Closure of the skin defect with skin flaps.

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