Abstract

SA.17.04

Comparison of the aesthetic outcome and complication rate of reconstructive surgical procedures of the eyelid after basalioma excision

Verena Engelmann, Sarah Pfrommer, Mounira J. Dridi, Johanna Piening, Chris Patrick Lohmann, Ralph-Laurent Merté
Klinik und Poliklinik für Augenheilkunde, Klinikum rechts der Isar, Technische Universität München, München

Objective
With about 90% of the eyelid tumors the basal cell cancer is the most common malignancy of the eyelid. The therapy of choice is the surgical removal. The main goal is the complete resection, which often demands great tissue defects and postulates a soft-tissue reconstruction. Aim of this study was to evaluate the subjective aesthetic outcome and the complication rate in consequence of the chosen surgical procedure.
Methods
57 patients were enclosed, who had surgery on a basal cell carcinoma of the eyelid between 2005 and 2008. After secured histopathological R0-resection the reconstructive surgery followed encluding either a free graft (24,6%), a Hughes flap (24,6%), an interpolated flap (22,8%) or if possible a primary wound closure (28,1%). The patients were examined to evaluate possible complications. Furthermore the patients satisfaction concerning the aesthetic outcome was assessed by a questionnaire.
Results
After an interpolated flap nearly 30% of the patients were without any complications and in the group treated with a Hughes flap 21,45%. In contrast 43,75% of the patients after  primary wound closure showed any complications and even 57% of the patients treated with a free graft. The most common complication was a malposition of the eyelid (ectropion).
Concerning the aesthetic outcome 92,3% of the patients undergoing an interpolated flap were subjective satisfied or even very satisfied with their aesthetic outcome. In contrast only 71,43% of the patients treated with a Hughes flap, 57,14% with a free graft and 62,5% with primary wound closure demonstrated at least a satisfying result.
Conclusions
The choice of the surgical procedure depends on the size, localization and anatomic conditions of the tissue defect. Regarding the complication rate the free graft and the primary wound closure seem to be superior. On the contrary the interpolated flap demonstrated with 92,3% satisfied patients a considerable better estimated aesthetic outcome.

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