PERIOCULAR RECONSTRUCTION - A SYSTEMATIC-APPROACH

The records and photographs of 90 patients who underwent reconstructiv e procedures on the eyelids, canthi, and periocular tissues between 19 82 and 1988 were reviewed retrospectively. The defects created by eith er fresh tissue histologically controlled resection or primary excisio n were analyzed according to location, size, and degree of resection a nd visual status. Histologic types included nodular, morphea, and fibr osing basal cell carcinomas; well to poorly differentiated squamous ce ll carcinoma; and melanoma in situ. The adequacy of both ocular protec tion and tissue preservation was assessed between 1 and 6 years postop eratively. Anatomic as well as functional reconstructions were perform ed with a complication rate of 12 percent. There were two tumor recurr ences requiring extensive craniofacial extirpation and reconstruction. A systematic method of classifying periocular defects was developed i n order to analyze various reconstructive options as well as the type and frequency of complications encountered. This classification system is applicable to primary benign and malignant lesions as well as defe cts. Analysis of patients who underwent periocular reconstruction in t he context of this classification system reveals that larger defects a nd those involving the medial canthus are more prone to complications. Recurrent complications in the medial and lateral canthal region unde rscore the necessity of routinely utilizing ancillary procedures such as lacrimal intubation and canthopexy. Recommendations for periocular reconstruction are suggested based on this classification system.