Videos of Surgical Procedures in Dermatology
Intraoperative Care During Eyelid Surgery
Cuidados intraoperatorios en cirugía palpebral
M.E. Iglesias-Zamora, S. Oscoz-Jaime
, A. Larumbe-Irurzun, B. Bonaut-Iriarte
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Servicio de Dermatología, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
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Iglesias-Zamora, S. Oscoz-Jaime, A. Larumbe-Irurzun, B. Bonaut-Iriarte" "autores" => array:4 [ 0 => array:2 [ "nombre" => "M.E." "apellidos" => "Iglesias-Zamora" ] 1 => array:4 [ "nombre" => "S." "apellidos" => "Oscoz-Jaime" "email" => array:1 [ 0 => "saioaoscoz@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Larumbe-Irurzun" ] 3 => array:2 [ "nombre" => "B." "apellidos" => "Bonaut-Iriarte" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Cuidados intraoperatorios en cirugía palpebral" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 800 "Ancho" => 773 "Tamanyo" => 82894 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Basal cell carcinoma at the medial canthus.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Reconstruction of defects of the eyelids after oncologic surgery can be complex. The techniques required at this site can be some of the most difficult in dermatologic surgery. After appropriate oncologic surgery to the eyelids, reconstruction must be extremely precise in order to preserve palpebral function.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> Optimal cosmetic and functional results can be achieved if, additionally, care is taken with a series of intraoperative factors.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Description of the Technique</span><p id="par0010" class="elsevierStylePara elsevierViewall">We present the surgical excision of a basal cell carcinoma affecting the free margin of the lower eyelid at the medial canthus, with reconstruction of the resulting defect, and we describe aspects of intraoperative care (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>). Prior to the intervention, we applied 4% lidocaine eyedrops and a protective hydroxypropylmethylcellulose gel. After infiltration of the skin, tarsus, and conjunctiva with 2% mepivacaine, an eye guard was inserted as a mechanical protector and a 3/0 silk suture was placed in the mid zone of the tarsus for traction and to facilitate mobilization of the lower eyelid during the operation. A dilator was used to visualize the 2 lacrimal ducts and we then proceeded to the full-thickness surgical excision of the lesion, with a wide surgical margin that included the inferior lacrimal duct.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> The incision was performed with a no. 15 scalpel, dissection with Stevens scissors, and meticulous hemostasis was performed with bipolar electrocautery (the patient had a pacemaker).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The resulting defect affected more than a quarter and less than a third of the length of the eyelid, making it necessary to perform a tension-releasing incision horizontally from the lateral canthus toward the lateral margin of the orbit (canthotomy). The deep part of the orbicularis oculi muscle was divided, positioning the scissors along the bisector of the angle of the lateral canthus.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> This allowed tension-free transposition and final closure of the defect. The tarsus was sutured to the medial canthal tendon with a 6/0 absorbable suture and the skin with 5/0 silk, taking care to align the gray line and fixing the free ends of the suture with Steri-Strips to prevent them damaging the cornea. The canthotomy was then closed by suturing the skin to the superior tarsus with 5/0 silk. The superior lacrimal duct was dilated to prevent epiphora, and finally we administered dexamethasone and tobramycin eyedrops.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Histology confirmed the diagnosis of basal cell carcinoma and the borders were free of tumor. The cosmetic and functional results 5 days and a month after the intervention were very good (<a class="elsevierStyleCrossRefs" href="#fig0010">Figures 2 and 3</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Indications</span><p id="par0025" class="elsevierStylePara elsevierViewall">This technique is suitable for patients with tumors that affect the free margin of the lower eyelid and whose surgical excision leaves a defect of between a quarter and a third of the length of the lower eyelid.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Advantages and Drawbacks</span><p id="par0030" class="elsevierStylePara elsevierViewall">Canthotomy allows defects of up to a third of the lower eyelid to be closed without tension.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The main drawback is that canthotomy is sometimes insufficient, and cantholysis must also be performed to release the lower eyelid from the orbital ring and achieve additional relaxation of the lower eyelid.</p><p id="par0040" class="elsevierStylePara elsevierViewall">In our patient, although the defect was slightly less than a third of the lower eyelid, canthotomy was performed in order to avoid tension that could provoke symptoms. Furthermore, as it was necessary to fix the tarsus to the medial canthal ligament, we considered it advisable to reduce tension as much as possible. This is a simple technique that does not carry major risks for the patient and that preserves eyelid function.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Complications</span><p id="par0045" class="elsevierStylePara elsevierViewall">The palpebral reconstruction we present is very safe, and complications are rare. One issue to avoid is leaving a notch at the palpebral margin; this can be prevented by careful suturing. In our patient, as the tumor affected the entire medial canthus, we had to fix the tarsus to the medial canthal ligament using an absorbable suture. Excessive tension in the lateral segment of the eyelid can provoke lateral ectropion.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Regarding intraoperative care, we would like to draw attention to the importance of protecting the surface of the eye both with lubricant gels and with mechanical guards to avoid possible complications from ocular damage. Apart from the metallic guard we present in the video, corneal shields are used throughout surgery to avoid injury to the cornea; these are more comfortable for patients operated under local anesthesia.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Considerations Regarding the Technique</span><p id="par0055" class="elsevierStylePara elsevierViewall">For the excision of lesions on the free border of the eyelid using the V technique, it is helpful to design a pentagonal V in the skin and a smaller V at the conjunctival border to facilitate closure of the defect.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclusions</span><p id="par0060" class="elsevierStylePara elsevierViewall">We have focused on the peculiarities of oncologic surgery of the eyelids. In addition to appropriate surgical excision and reconstruction, eyelid function must be preserved to avoid adverse effects that could damage the anterior pole of the eye and affect visual acuity. It is important to use the correct instruments for intraoperative care.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of Interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Description of the Technique" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Indications" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Advantages and Drawbacks" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Complications" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Considerations Regarding the Technique" ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Conclusions" ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflicts of Interest" ] 8 => array:2 [ "identificador" => "xack253812" "titulo" => "Acknowledgments" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Iglesias-Zamora ME, Oscoz-Jaime S, Larumbe-Irurzun A, Bonaut-Iriarte B. Cuidados intraoperatorios en cirugía palpebral. Actas Dermosifiliogr. 2016;107:855–857.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">The video received 2nd prize in the first “Best Video in Dermatologic Surgery” competition organized by the Spanish Academy of Dermatology and Venereology (AEDV), and was screened at the XXVIII Meeting of AEDV's Dermatologic Surgery, Cutaneous Oncology and Laser Therapy Group held in Valencia on 27 and 28 November, 2015.</p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0080" class="elsevierStylePara elsevierViewall">The following are the supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Additional Material" "identificador" => "sec0050" ] ] ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 800 "Ancho" => 773 "Tamanyo" => 82894 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Basal cell carcinoma at the medial canthus.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 708 "Ancho" => 800 "Tamanyo" => 81622 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Result 5 days after the operation.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 577 "Ancho" => 800 "Tamanyo" => 60400 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Result 1 month after the operation.</p>" ] ] 3 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc1.mp4" "ficheroTamanyo" => 206530658 "Video" => array:2 [ "mp4" => array:2 [ "fichero" => "mmc1.m4v" "poster" => "mmc1.jpg" ] "flv" => array:5 [ "fichero" => "mmc1.flv" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0025" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "F.J. Vázquez Doval" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:6 [ "edicion" => "1.<span class="elsevierStyleSup">a</span> edición" "fecha" => "2013" "paginaInicial" => "94" "paginaFinal" => "138" "editorial" => "Springer" "editorialLocalizacion" => "España" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0030" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Atlas of aesthetic eyelid and periocular surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "H.M. Spinelli" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:5 [ "fecha" => "2004" "paginaInicial" => "1" "paginaFinal" => "27" "editorial" => "WB Saunders" "editorialLocalizacion" => "Philadelphia" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0035" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reconstrucción del párpado y región cantal. Colgajos locales en la reconstrucción de cabeza y cuello" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "I.T. Jackson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:5 [ "fecha" => "1990" "paginaInicial" => "273" "paginaFinal" => "323" "editorial" => "Salvat" "editorialLocalizacion" => "España" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0040" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cirugía oncológica del párpado y la región orbitaria" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.E. Iglesias" 1 => "R. Santesteban" 2 => "A. Larumbe" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ad.2014.11.011" "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2015" "volumen" => "106" "paginaInicial" => "365" "paginaFinal" => "375" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25701895" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack253812" "titulo" => "Acknowledgments" "texto" => "<p id="par0070" class="elsevierStylePara elsevierViewall">We would like to thank Xabier Belzunegui of the Communication and Design Unit of Navarra Biomed for recording and editing the video.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010700000010/v1_201611260103/S1578219016302347/v1_201611260103/en/main.assets" "Apartado" => array:4 [ "identificador" => "6209" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Videos of Surgical Procedures in Dermatology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010700000010/v1_201611260103/S1578219016302347/v1_201611260103/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219016302347?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 9 | 14 | 23 |
| 2024 Octubre | 87 | 43 | 130 |
| 2024 Septiembre | 86 | 24 | 110 |
| 2024 Agosto | 109 | 44 | 153 |
| 2024 Julio | 101 | 26 | 127 |
| 2024 Junio | 85 | 24 | 109 |
| 2024 Mayo | 91 | 32 | 123 |
| 2024 Abril | 67 | 16 | 83 |
| 2024 Marzo | 86 | 29 | 115 |
| 2024 Febrero | 68 | 28 | 96 |
| 2024 Enero | 79 | 29 | 108 |
| 2023 Diciembre | 59 | 13 | 72 |
| 2023 Noviembre | 77 | 23 | 100 |
| 2023 Octubre | 71 | 13 | 84 |
| 2023 Septiembre | 59 | 25 | 84 |
| 2023 Agosto | 68 | 27 | 95 |
| 2023 Julio | 54 | 24 | 78 |
| 2023 Junio | 61 | 20 | 81 |
| 2023 Mayo | 59 | 23 | 82 |
| 2023 Abril | 47 | 19 | 66 |
| 2023 Marzo | 55 | 30 | 85 |
| 2023 Febrero | 42 | 25 | 67 |
| 2023 Enero | 39 | 34 | 73 |
| 2022 Diciembre | 49 | 46 | 95 |
| 2022 Noviembre | 28 | 21 | 49 |
| 2022 Octubre | 26 | 23 | 49 |
| 2022 Septiembre | 23 | 40 | 63 |
| 2022 Agosto | 25 | 27 | 52 |
| 2022 Julio | 35 | 35 | 70 |
| 2022 Junio | 13 | 24 | 37 |
| 2022 Mayo | 34 | 29 | 63 |
| 2022 Abril | 39 | 37 | 76 |
| 2022 Marzo | 35 | 38 | 73 |
| 2022 Febrero | 37 | 25 | 62 |
| 2022 Enero | 36 | 33 | 69 |
| 2021 Diciembre | 34 | 42 | 76 |
| 2021 Noviembre | 43 | 40 | 83 |
| 2021 Octubre | 41 | 52 | 93 |
| 2021 Septiembre | 26 | 37 | 63 |
| 2021 Agosto | 20 | 27 | 47 |
| 2021 Julio | 19 | 24 | 43 |
| 2021 Junio | 25 | 21 | 46 |
| 2021 Mayo | 28 | 36 | 64 |
| 2021 Abril | 34 | 43 | 77 |
| 2021 Marzo | 31 | 24 | 55 |
| 2021 Febrero | 29 | 21 | 50 |
| 2021 Enero | 20 | 11 | 31 |
| 2020 Diciembre | 20 | 9 | 29 |
| 2020 Noviembre | 22 | 23 | 45 |
| 2020 Octubre | 15 | 9 | 24 |
| 2020 Septiembre | 22 | 13 | 35 |
| 2020 Agosto | 24 | 17 | 41 |
| 2020 Julio | 15 | 12 | 27 |
| 2020 Junio | 28 | 33 | 61 |
| 2020 Mayo | 21 | 11 | 32 |
| 2020 Abril | 22 | 13 | 35 |
| 2020 Marzo | 25 | 15 | 40 |
| 2020 Febrero | 3 | 0 | 3 |
| 2020 Enero | 4 | 0 | 4 |
| 2019 Diciembre | 4 | 0 | 4 |
| 2019 Noviembre | 4 | 0 | 4 |
| 2019 Septiembre | 4 | 0 | 4 |
| 2019 Agosto | 4 | 0 | 4 |
| 2019 Julio | 4 | 0 | 4 |
| 2019 Junio | 4 | 0 | 4 |
| 2019 Mayo | 4 | 2 | 6 |
| 2019 Abril | 2 | 4 | 6 |
| 2019 Febrero | 2 | 0 | 2 |
| 2019 Enero | 3 | 0 | 3 |
| 2018 Diciembre | 3 | 0 | 3 |
| 2018 Noviembre | 24 | 0 | 24 |
| 2018 Octubre | 1 | 0 | 1 |
| 2018 Septiembre | 4 | 0 | 4 |
| 2018 Febrero | 21 | 0 | 21 |
| 2018 Enero | 34 | 13 | 47 |
| 2017 Diciembre | 34 | 8 | 42 |
| 2017 Noviembre | 22 | 4 | 26 |
| 2017 Octubre | 26 | 7 | 33 |
| 2017 Septiembre | 21 | 15 | 36 |
| 2017 Agosto | 23 | 7 | 30 |
| 2017 Julio | 30 | 8 | 38 |
| 2017 Junio | 37 | 14 | 51 |
| 2017 Mayo | 20 | 5 | 25 |
| 2017 Abril | 37 | 12 | 49 |
| 2017 Marzo | 25 | 23 | 48 |
| 2017 Febrero | 23 | 4 | 27 |
| 2017 Enero | 25 | 8 | 33 |
| 2016 Diciembre | 80 | 33 | 113 |
| 2016 Noviembre | 23 | 25 | 48 |
| 2016 Octubre | 2 | 5 | 7 |
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