Clinical Analysis Of Cosmetic Repair After Surgical Resection Of The Divided Nevus Of Eyelid

Objective:To explore the experiences and methods of the management of 22 cases of divided nevus of eyelid with surgical resection and personalized cosmetic repair.Methods:Between January 2010 and December 2016,22 patients aged from 5 to 38 years old(average age 19.2 years)in our department who were diagnosed as divided nevus of eyelid and treated by repair surgery were selected in this study.8 cases were male and 14 female.Left eye was involved in 10 cases,and right eye in 12 cases.The diseased region of 10 cases were near the inner canthus,2 cases in the central,8 cases near the outer canthus,2 cases involving the whole eyelid,8 cases involving eyelid margin and conjunctiva,14 cases involving only the shallow.The area of the nevus ranged from0.4cm×0.3cm to 2.3cm×1.5cm in upper eyelid,and 0.3cm×0.2cm to2.5cm×2.4cm in lower eyelid.When we design the repair flaps,we should consider several aspects,such as the location,shape,area and depth of the nevus,the skin relaxation,age and the requirements of the appearance of post-operation of the patients,the cost of repair and other aspects,to achieve perfect cosmetic effect.The patients were followed up at 1,3,6 and 12 months after operation,we do the evaluation based on bilateral symmetry eyelids,scar,eyelid activity,eyelid shrinking,eyelid ectropion,upper eyelid swollen,angle of inner and outer canthus deformity,recurrence of divided nevus,comfort level.We have no control group.Results:We followed up the patients at 1,3,6 and 12 months after the operation.Flaps survived well and wounds healed primarily in all cases.The symmetry of eyes is well and the scars are not obvious.The eyelid activities were natural.No eyelid ectropion,upper eyelid swollen,and recurrence was found.No discomfort of eyes was found.20 cases were produced for desirable eyelid contour.1 case had mild lower eyelid shrinking.We did the correction operation using the lower palpebral margin incision to suspend the external canthal ligament.Postoperative clinical result was satisfactory.The canthus angle of 1 case was mildly deformed and palpebral fissure shorter slightly,but does not affect the overall appearance.Conclusion:1.Advanced skin flap should be preferred in the treatment of divided nevus of eyelid,it should be combined with other local flaps flexibility to repair the defect.2.Lower eyelid nevus with larger area should be repaired with island flap pedicled with orbicularis oculi muscle.3.Eyelid margin and palpebral conjunctiva can be retained appropriately if they are involved.The patients should be followed up regularly.4.The incision of various flaps should be concealed,which means close to the eyelid,eyebrow or paralleled to skin lines,wrinkle lines,contour lines,and the amount should be as less as possible to minimal scars.5.The design of the operation should be personalization according to the location,shape,area and depth of the nevus,the skin relaxation,age and the requirements of the appearance of post-operation of the patients,the cost of repair and other aspects.