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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The most common tumor of the eyelids is basal cell carcinoma&#46; At this site&#44; excision can be performed using Mohs micrographic surgery&#46; Reconstruction of the upper or lower eyelids is a challenge due to their structural complexity and their important function&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The eyelid has classically been divided into the anterior lamella&#44; comprising skin&#44; subcutaneous cellular tissue&#44; and the orbicularis oculi muscle&#44; and the posterior lamella&#44; comprising the tarsus and the palpebral conjunctiva&#46; In the posterior lamella&#44; the tarsus provides fibrous and cartilaginous support to the eyelid as it is anchored to the periosteum of the orbit medially and laterally by the canthal ligaments&#46; Successful eyelid reconstruction requires the repair of both subunits&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">At the present time&#44; the techniques most widely used for the reconstruction of full-thickness defects of the posterior lamella of the lower eyelid are divided into tarsoconjunctival flaps&#44; chondromucosal grafts&#44; and chondroperichondral grafts&#46; All these can be combined with skin flaps or grafts for reconstruction of the anterior lamella&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The classic Hughes flap&#44; a tarsoconjunctival flap&#44; merits special mention&#46; This transposition flap from the upper eyelid is indicated for &#189; to &#190; defects of the lower eyelid&#46; Larger defects would lead to unacceptable morbidity of the upper eyelid&#46; In lateral or medial defects of the lower eyelid&#44; a semicircular myocutaneous advancement flap or Tenzel flap can be used&#59; by releasing the lateral canthus&#44; this method allows direct closure of the defect with identical tissue&#46; Neither of the above flaps would have been flaps of choice in our case due to the size and site of the defect&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In the case of chondromucosal grafts&#44; possible donor sites are the nasal septum and the hard palate&#44; though both options are technically more complex and carry a higher morbidity&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The auricular chondroperichondral graft&#44; using tissue obtained from the concha of the ear &#40;from the posterior aspect of the concha in our case&#41;&#44; is a relatively simple surgical technique and produces minimal morbidity at the donor site&#46; Furthermore&#44; the auricular cartilage is easily shaped and it prevents to some extent the postsurgical retraction of the skin flap that is chosen&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Technique</span><p id="par0035" class="elsevierStylePara elsevierViewall">We describe the case of a 67-year-old patient with no past medical history of interest&#44; who presented recurrence of a basal cell carcinoma affecting the malar region and left lower eyelid&#46; Physical examination revealed a sclerotic&#44; infiltrated plaque with poorly defined borders located in the upper left malar region&#44; adjacent to the ala nasi and to the lower eyelid &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Eight stages of Mohs micrographic surgery left a surgical defect involving the mid cheek&#44; a large part of the lower eyelid&#44; including the tarsus&#44; and the left side of the dorsum of the nose &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; The medial canthus and the lacrimal apparatus were preserved&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The video shows the reconstruction of the defect under local anesthesia&#46; After placement of the auricular chondroperichondral graft&#44; the anterior lamella of the eyelid and the rest of the surgical defect were reconstructed using a labial advancement flap&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Indications</span><p id="par0050" class="elsevierStylePara elsevierViewall">This technique is indicated for the reconstruction of full-thickness defects of the lower eyelid that cannot be closed by direct suture&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Contraindications</span><p id="par0055" class="elsevierStylePara elsevierViewall">A relative contraindication is when the conjunctiva is not preserved&#46; Even though this type of chondroperichondral graft shows rapid re-epithelialization&#44; troublesome corneal irritation can develop&#44; though it is usually transitory&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Complications</span><p id="par0060" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0065" class="elsevierStylePara elsevierViewall">Surgical wound infection affecting the eyelid or ear &#40;chondritis&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0070" class="elsevierStylePara elsevierViewall">Necrosis of the cartilaginous graft&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0075" class="elsevierStylePara elsevierViewall">Edema&#44; hematoma&#44; or distal necrosis of the advancement flap on the cheek&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0080" class="elsevierStylePara elsevierViewall">Postsurgical ectropion due to unpredictable wrapping of the cartilage&#46;</p></li></ul></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Alternatives</span><p id="par0145" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">-</span><p id="par0085" class="elsevierStylePara elsevierViewall">The Hughes tarsoconjunctival flap&#46; This requires a second operation&#44; with the eye remaining covered in the interval between operations&#46; It must be combined with a graft or flap for reconstruction of the anterior lamella&#46; The defect in our patient was too large to use tissue from the upper eyelid&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">-</span><p id="par0090" class="elsevierStylePara elsevierViewall">The Mustard&#233; cheek rotation flap&#46; As in our case&#44; the posterior lamella must be reconstructed with a cartilage graft or a tarsoconjunctival flap&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">-</span><p id="par0095" class="elsevierStylePara elsevierViewall">Mucosal plus periostial&#47;perichondrial graft from the hard palate&#47;nasal septum&#46; These are both excellent options&#44; but obtaining the material is laborious and there is considerable postoperative pain&#46; There are certain significant risks&#44; such as iatrogenic perforation or nasal collapse&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">-</span><p id="par0100" class="elsevierStylePara elsevierViewall">Island nasal chondromucosal flaps&#46; These are relatively complex techniques&#46; The blood supply to the flap comes from a terminal branch of the dorsal nasal artery&#46; Septal chondromucosal flaps have also been described&#46; After dissection of the flaps&#44; they are tunneled to their final position on the lower eyelid&#46; Despite donor site morbidity&#44; it is true that these flaps provide a sufficient quantity of similar tissue for full-thickness reconstruction without damaging the upper eyelid&#46; Their main disadvantages&#44; apart from those mentioned&#44; are a trap door effect of the flap that can affect functional and cosmetic outcomes&#44; and the need for a second operation&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">-</span><p id="par0105" class="elsevierStylePara elsevierViewall">Autologous&#47;homologous fascia lata&#46; Homologous fascia lata carries a risk of transmission of infectious diseases &#40;human immunodeficiency virus&#44; hepatitis&#44; Creutzfeld-Jacob disease&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> In the case of autologous fascia lata&#44; the main problems come from the difficulty of obtaining the tissue&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p></li></ul></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclusions</span><p id="par0110" class="elsevierStylePara elsevierViewall">There are certain sites in the body that can be a challenge to the dermatologic surgeon&#59; the eyelids are one of these sites&#46; The need to provide adequate support to this structure requires complex techniques that may not always be familiar to the surgeon&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">In our case&#44; through a laborious reconstruction using a known and simple technique that required a single surgical intervention&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> we performed reconstruction of the lower eyelid with a good functional and cosmetic outcome &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">We believe it useful to publish a description of the use of conchal cartilage for full-thickness defects of the lower eyelid as&#44; after completing the oncologic surgery&#44; in our opinion it should be the dermatologist who performs the reconstruction&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of Interest</span><p id="par0125" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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Videos of Surgical Procedures in Dermatology
Auricular Chondro-Perichondrial Graft in the Reconstruction of the Lower Eyelid
Injerto condro-pericóndrico auricular en la reconstrucción del párpado inferior
M.M. Otero Rivas
Autor para correspondencia
motero@aedv.es

Corresponding author.
, H.A. Cocunubo Blanco, B. González Sixto, M.Á. Rodríguez Prieto
Servicio de Dermatología, Complejo Asistencial Universitario de León, León, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The most common tumor of the eyelids is basal cell carcinoma&#46; At this site&#44; excision can be performed using Mohs micrographic surgery&#46; Reconstruction of the upper or lower eyelids is a challenge due to their structural complexity and their important function&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The eyelid has classically been divided into the anterior lamella&#44; comprising skin&#44; subcutaneous cellular tissue&#44; and the orbicularis oculi muscle&#44; and the posterior lamella&#44; comprising the tarsus and the palpebral conjunctiva&#46; In the posterior lamella&#44; the tarsus provides fibrous and cartilaginous support to the eyelid as it is anchored to the periosteum of the orbit medially and laterally by the canthal ligaments&#46; Successful eyelid reconstruction requires the repair of both subunits&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">At the present time&#44; the techniques most widely used for the reconstruction of full-thickness defects of the posterior lamella of the lower eyelid are divided into tarsoconjunctival flaps&#44; chondromucosal grafts&#44; and chondroperichondral grafts&#46; All these can be combined with skin flaps or grafts for reconstruction of the anterior lamella&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The classic Hughes flap&#44; a tarsoconjunctival flap&#44; merits special mention&#46; This transposition flap from the upper eyelid is indicated for &#189; to &#190; defects of the lower eyelid&#46; Larger defects would lead to unacceptable morbidity of the upper eyelid&#46; In lateral or medial defects of the lower eyelid&#44; a semicircular myocutaneous advancement flap or Tenzel flap can be used&#59; by releasing the lateral canthus&#44; this method allows direct closure of the defect with identical tissue&#46; Neither of the above flaps would have been flaps of choice in our case due to the size and site of the defect&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In the case of chondromucosal grafts&#44; possible donor sites are the nasal septum and the hard palate&#44; though both options are technically more complex and carry a higher morbidity&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The auricular chondroperichondral graft&#44; using tissue obtained from the concha of the ear &#40;from the posterior aspect of the concha in our case&#41;&#44; is a relatively simple surgical technique and produces minimal morbidity at the donor site&#46; Furthermore&#44; the auricular cartilage is easily shaped and it prevents to some extent the postsurgical retraction of the skin flap that is chosen&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Technique</span><p id="par0035" class="elsevierStylePara elsevierViewall">We describe the case of a 67-year-old patient with no past medical history of interest&#44; who presented recurrence of a basal cell carcinoma affecting the malar region and left lower eyelid&#46; Physical examination revealed a sclerotic&#44; infiltrated plaque with poorly defined borders located in the upper left malar region&#44; adjacent to the ala nasi and to the lower eyelid &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Eight stages of Mohs micrographic surgery left a surgical defect involving the mid cheek&#44; a large part of the lower eyelid&#44; including the tarsus&#44; and the left side of the dorsum of the nose &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; The medial canthus and the lacrimal apparatus were preserved&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The video shows the reconstruction of the defect under local anesthesia&#46; After placement of the auricular chondroperichondral graft&#44; the anterior lamella of the eyelid and the rest of the surgical defect were reconstructed using a labial advancement flap&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Indications</span><p id="par0050" class="elsevierStylePara elsevierViewall">This technique is indicated for the reconstruction of full-thickness defects of the lower eyelid that cannot be closed by direct suture&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Contraindications</span><p id="par0055" class="elsevierStylePara elsevierViewall">A relative contraindication is when the conjunctiva is not preserved&#46; Even though this type of chondroperichondral graft shows rapid re-epithelialization&#44; troublesome corneal irritation can develop&#44; though it is usually transitory&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Complications</span><p id="par0060" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0065" class="elsevierStylePara elsevierViewall">Surgical wound infection affecting the eyelid or ear &#40;chondritis&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0070" class="elsevierStylePara elsevierViewall">Necrosis of the cartilaginous graft&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0075" class="elsevierStylePara elsevierViewall">Edema&#44; hematoma&#44; or distal necrosis of the advancement flap on the cheek&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0080" class="elsevierStylePara elsevierViewall">Postsurgical ectropion due to unpredictable wrapping of the cartilage&#46;</p></li></ul></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Alternatives</span><p id="par0145" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">-</span><p id="par0085" class="elsevierStylePara elsevierViewall">The Hughes tarsoconjunctival flap&#46; This requires a second operation&#44; with the eye remaining covered in the interval between operations&#46; It must be combined with a graft or flap for reconstruction of the anterior lamella&#46; The defect in our patient was too large to use tissue from the upper eyelid&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">-</span><p id="par0090" class="elsevierStylePara elsevierViewall">The Mustard&#233; cheek rotation flap&#46; As in our case&#44; the posterior lamella must be reconstructed with a cartilage graft or a tarsoconjunctival flap&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">-</span><p id="par0095" class="elsevierStylePara elsevierViewall">Mucosal plus periostial&#47;perichondrial graft from the hard palate&#47;nasal septum&#46; These are both excellent options&#44; but obtaining the material is laborious and there is considerable postoperative pain&#46; There are certain significant risks&#44; such as iatrogenic perforation or nasal collapse&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">-</span><p id="par0100" class="elsevierStylePara elsevierViewall">Island nasal chondromucosal flaps&#46; These are relatively complex techniques&#46; The blood supply to the flap comes from a terminal branch of the dorsal nasal artery&#46; Septal chondromucosal flaps have also been described&#46; After dissection of the flaps&#44; they are tunneled to their final position on the lower eyelid&#46; Despite donor site morbidity&#44; it is true that these flaps provide a sufficient quantity of similar tissue for full-thickness reconstruction without damaging the upper eyelid&#46; Their main disadvantages&#44; apart from those mentioned&#44; are a trap door effect of the flap that can affect functional and cosmetic outcomes&#44; and the need for a second operation&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">-</span><p id="par0105" class="elsevierStylePara elsevierViewall">Autologous&#47;homologous fascia lata&#46; Homologous fascia lata carries a risk of transmission of infectious diseases &#40;human immunodeficiency virus&#44; hepatitis&#44; Creutzfeld-Jacob disease&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> In the case of autologous fascia lata&#44; the main problems come from the difficulty of obtaining the tissue&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p></li></ul></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclusions</span><p id="par0110" class="elsevierStylePara elsevierViewall">There are certain sites in the body that can be a challenge to the dermatologic surgeon&#59; the eyelids are one of these sites&#46; The need to provide adequate support to this structure requires complex techniques that may not always be familiar to the surgeon&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">In our case&#44; through a laborious reconstruction using a known and simple technique that required a single surgical intervention&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> we performed reconstruction of the lower eyelid with a good functional and cosmetic outcome &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">We believe it useful to publish a description of the use of conchal cartilage for full-thickness defects of the lower eyelid as&#44; after completing the oncologic surgery&#44; in our opinion it should be the dermatologist who performs the reconstruction&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of Interest</span><p id="par0125" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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Información del artículo
ISSN: 15782190
Idioma original: Inglés
DOI:10.1016/j.adengl.2013.11.001
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