Abstract Based on 22 cases, the assessment and meth-
ods of reconstructing both the upper and lower eyelids
are described. Galea and prefabricated retroauricular
flaps were used in the majority of cases. When concomi-
tant defects and deformities were present, additional pro-
cedures are discussed, with special emphasis given to
shortcomings, difficulties and complications.
Keywords Eyelid reconstruction · Orbit exenteration ·
Total destruction of both eyelids occurs mostly as a re-
sult of exenteration or, less often, severe trauma to the
orbital region, such as an electric burn, gunshot or road
traffic injury. Ablative surgery is usually followed by ir-
radiation, which is especially harmful to the orbital area
in children. Growth impairment is not only limited to the
orbital region but, in some cases, it also can involve the
total hemiface. The typical abnormalities are as follows:
underdeveloped and deformed orbits, irradiated skin,
hairless eyebrows, a thin and tight soft tissue envelope,
weak frontal muscle and fistulae. Large defects of the or-
bital walls and surrounding anatomical structures pro-
duced by compound resections or severe trauma result in
challenging reconstructive problems.
Surgical repair of the abnormalities listed above is
rather uncommon because it is frequently imperfect, is
difficult, takes a long time, and is expensive [20, 31].
Thus, according to many surgeons, prosthetic treatment
is more reasonable and, therefore, recommended [6, 18].
Because prostheses of good quality are not always avail-
able, and since many younger patients wish to have sur-
gical reconstruction, the author’s approach and experi-
ence with this problem will be presented.
The material consists of 22 patients, ranging in age from
0.7 to 52 years, treated at the Hospital for Plastic Surgery
in Polanica Zdrój between 1976 and 1999 (Table 1).
The majority of patients had exenteration of the orbit
followed by irradiation in early childhood (1–4 years
old). As a result of this, almost all of the previously list-
ed post-radiation abnormalities were noted, and micro-
orbitism was the most typical feature. Hemifacial hypo-
plasia was observed in two patients and was similar to
that seen in severe Romberg’s disease.
In adult patients who had previously excised malig-
nancies, the most characteristic problems were fistulae
and large post-excisional orbitomaxillary defects.
The final group consisted of patients with concomi-
tant destruction of the nose and frontal area after road
traffic injuries and high-voltage electric burns.
The surgical treatment consisted of a preliminary operation, fol-
lowed by basic procedures and refinements; this is modified ac-
cording to the severity of the defects and deformities.
In the initial cases, the preliminary operations consisted of
closing any orbital fistulae together with orbital wall augmentation
to allow an ocular prosthesis of a normal size to be inserted.
In five patients, the orbitonasal and/or maxillo-orbital fistulae
were repaired by frontal island flaps (2), local tissue (2), and dis-
tant flap (1).
As experience was acquired, repairing the orbital walls was
abandoned since it was felt to be unnecessary. This was determined
because of problems with reconstructing extensive defects, and
also because a new “curtain method” was developed. This enabled
eyelid and conjunctival sac reconstruction in spite of existing fistu-
lae and orbital wall deficiency. This will be discussed later.
When considering orbital rim augmentation, problems were
encountered due to shortage and the bad quality of the irradiated
K. Kobus (
Polanica Zdrój, ul. Boczna 2 A, Poland
Hospital of Plastic Surgery, Polanica Zdrój,
Chair of Traumatology and Hand Surgery, Medical Academy,
Tel.: +48-074-8681047, Fax: +48-074-8681047
Eur J Plast Surg (2002) 24:321–327
Reconstructing the eyelids after exenteration and trauma
Received: 26 April 2001 / Accepted: 18 September 2001 / Published online: 21 December 2001
© Springer-Verlag 2001