Repair of eyelid and periocular soft tissue defects with Pacman flap_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LI Guangxue , LIN Zhiyu , LIU Yan , WANG Cai , ZANG Huiran ,  YANG Kai

Department of Plastic and Reconstructive Surgery, Peking University People’s Hospital, Beijing, 100044, P.R.China;

Corresponding author：

YANG Kai, Email: ykliutt@163.com

Keywords：

Eyelid; periocular; soft tissue defect; Pacman flap; repair

DOI：

10.7507/1002-1892.202106066

Video：

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Objective To explore the effectiveness and safety of Pacman flap for repair of eyelid and periocular soft tissue defects. Methods The clinical data of 12 patients who underwent repair of eyelid and periocular soft tissue defects with Pacman flap between April 2015 and September 2020 was retrospectively reviewed. There were 5 males and 7 females, aged from 18 to 87 years, with a median age of 63 years. The disease duration ranged from 6 months to 50 years, with a median time of 3 years. The defect was located on the lateral eyelid in 5 cases, inferior eyelid in 3 cases, inferior and medial eyelid in 2 cases, inferior and lateral eyelid in 2 cases, and lateral eyebrow in 1 case. Pathological diagnosis included 4 cases of basal cell carcinoma, 4 cases of squamous cell carcinoma, 1 case of junction nevus, 1 case of intradermal nevus, 1 case of seborrheic keratosis, and 1 case of keratoacanthoma. The size of defects ranged from 1.4 cm×1.2 cm to 5.5 cm×5.0 cm. According to the skin mobility and toughness around the defects, Pacman flaps with the size of 1.6 cm×1.4 cm to 10.0 cm×6.0 cm were designed and advanced to repair the defects. Results All flaps survived completely with no necrosis. One patient had infection, and another patient had partial wound dehiscence, but the wounds healed after dressing change without further debridement. Other patients all recovered successfully. The follow-up time ranged from4 to 51 months, with a median time of 12 months. No recurrence and metastasis occurred, and the scars were invisible without deformity of eyelid and brow. All patients were satisfied with the aesthetic and functional outcomes of the eyes. Conclusion Pacman flap is a simple and feasible technique for repair of eyelid and periocular soft tissue defects, with satisfactory effectiveness.

Citation： LI Guangxue, LIN Zhiyu, LIU Yan, WANG Cai, ZANG Huiran, YANG Kai. Repair of eyelid and periocular soft tissue defects with Pacman flap. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(11): 1463-1466. doi: 10.7507/1002-1892.202106066 Copy

1.	李伟东, 蔡静敬, 郭琳, 等. 风筝样皮瓣修复眼睑及其周围皮肤缺损的临床效果. 中华医学美学美容杂志, 2018, 24(4): 260-263.
2.	邹运, 胡丽, 金云波, 等. 大面积横向推进及眼周隐蔽切口眦定位手术修复眶周皮肤缺损. 组织工程与重建外科杂志, 2016, 12(4): 251-253.
3.	Connolly KL, Nehal KS, Disa JJ. Evidence-based medicine: Cutaneous facial malignancies: nonmelanoma skin cancer. Plast Reconstr Surg, 2017, 139(1): 181e-190e.
4.	Lu GN, Pelton RW, Humphrey CD, et al. Defect of the eyelids. Facial Plast Surg Clin North Am, 2017, 25(3): 377-392.
5.	Chang EI, Esmaeli B, Butler CE. Eyelid reconstruction. Plast Reconstr Surg, 2017, 140(5): 724e-735e.
6.	Zlatarova ZI, Nenkova BN, Softova EB. Eyelid reconstruction with full thickness skin grafts after carcinoma excision. Folia Med (Plovdiv), 2016, 58(1): 42-47.
7.	Bortz JG, Al-Shweiki S. Free tarsal graft and free skin graft for lower eyelid reconstruction. Ophthalmic Plast Reconstr Surg, 2020, 36(6): 605-609.
8.	周愔, 王丽霞, 王晓英, 等. 眼轮匝肌推进皮瓣结合重睑成形术修复睑黄瘤切除缺损的临床效果. 中华医学美学美容杂志, 2020, 26(4): 352-353.
9.	Choi EJ, Oh TM, Han HH. A modified surgical method combined with blepharoplasty design for treatment of xanthelasma palpebrarum. Biomed Res Int, 2020, 2020: 4803168. doi: 10.1155/2020/4803168.
10.	Kim GW, Bae YC, Kim JH, et al. Usefulness of the orbicularis oculi myocutaneous flap in periorbital reconstruction. Arch Craniofac Surg, 2018, 19(4): 254-259.
11.	Lewin JM, Sclafani AP, Carucci JA. An inferiorly based rotation flap for defects involving the lower eyelid and medial cheek. Facial Plast Surg, 2015, 31(4): 411-416.
12.	Albanese G, Kasbekar S, Abercrombie LC. Modified cheek advancement flap for medial lower eyelid, nasal sidewall and infraorbital cheek reconstruction: a case series. Orbit, 2020, 39(2): 123-127.
13.	Uslu A. Use of a perforator/subcutaneous pedicled propeller flap for reconstruction of lower eyelid defects. J Plast Reconstr Aesthet Surg, 2019, 72(1): 119-124.
14.	Keçeci Y, Bali ZU, Ahmedov A, et al. Angular artery island flap for eyelid defect reconstruction. J Plast Surg Hand Surg, 2020, 54(1): 1-5.
15.	Yang M, Zhao Y. Reconstruction of full-thickness lower eyelid defect using superficial temporal artery island flap combined with auricular cartilage graft. J Craniofac Surg, 2015, 26(2): 576-579.
16.	Aoki R, Hyakusoku H. Pacman flap method. Plast Reconstr Surg, 2007, 119(6): 1799-1802.
17.	Oh SH, Kwon H, Kim SJ, et al. Bilateral interdigitated Pacman flap for round and oval facial defects. J Craniomaxillofac Surg, 2018, 46(6): 1032-1036.
18.	Sugg KB, Cederna PS, Brown DL. The V-Y advancement flap is equivalent to the Mustardé flap for ectropion prevention in the reconstruction of moderate-size lid-cheek junction defects. Plast Reconstr Surg, 2013, 131(1): 28e-36e.

1. 李伟东, 蔡静敬, 郭琳, 等. 风筝样皮瓣修复眼睑及其周围皮肤缺损的临床效果. 中华医学美学美容杂志, 2018, 24(4): 260-263.
2. 邹运, 胡丽, 金云波, 等. 大面积横向推进及眼周隐蔽切口眦定位手术修复眶周皮肤缺损. 组织工程与重建外科杂志, 2016, 12(4): 251-253.
3. Connolly KL, Nehal KS, Disa JJ. Evidence-based medicine: Cutaneous facial malignancies: nonmelanoma skin cancer. Plast Reconstr Surg, 2017, 139(1): 181e-190e.
4. Lu GN, Pelton RW, Humphrey CD, et al. Defect of the eyelids. Facial Plast Surg Clin North Am, 2017, 25(3): 377-392.
5. Chang EI, Esmaeli B, Butler CE. Eyelid reconstruction. Plast Reconstr Surg, 2017, 140(5): 724e-735e.
6. Zlatarova ZI, Nenkova BN, Softova EB. Eyelid reconstruction with full thickness skin grafts after carcinoma excision. Folia Med (Plovdiv), 2016, 58(1): 42-47.
7. Bortz JG, Al-Shweiki S. Free tarsal graft and free skin graft for lower eyelid reconstruction. Ophthalmic Plast Reconstr Surg, 2020, 36(6): 605-609.
8. 周愔, 王丽霞, 王晓英, 等. 眼轮匝肌推进皮瓣结合重睑成形术修复睑黄瘤切除缺损的临床效果. 中华医学美学美容杂志, 2020, 26(4): 352-353.
9. Choi EJ, Oh TM, Han HH. A modified surgical method combined with blepharoplasty design for treatment of xanthelasma palpebrarum. Biomed Res Int, 2020, 2020: 4803168. doi: 10.1155/2020/4803168.
10. Kim GW, Bae YC, Kim JH, et al. Usefulness of the orbicularis oculi myocutaneous flap in periorbital reconstruction. Arch Craniofac Surg, 2018, 19(4): 254-259.
11. Lewin JM, Sclafani AP, Carucci JA. An inferiorly based rotation flap for defects involving the lower eyelid and medial cheek. Facial Plast Surg, 2015, 31(4): 411-416.
12. Albanese G, Kasbekar S, Abercrombie LC. Modified cheek advancement flap for medial lower eyelid, nasal sidewall and infraorbital cheek reconstruction: a case series. Orbit, 2020, 39(2): 123-127.
13. Uslu A. Use of a perforator/subcutaneous pedicled propeller flap for reconstruction of lower eyelid defects. J Plast Reconstr Aesthet Surg, 2019, 72(1): 119-124.
14. Keçeci Y, Bali ZU, Ahmedov A, et al. Angular artery island flap for eyelid defect reconstruction. J Plast Surg Hand Surg, 2020, 54(1): 1-5.
15. Yang M, Zhao Y. Reconstruction of full-thickness lower eyelid defect using superficial temporal artery island flap combined with auricular cartilage graft. J Craniofac Surg, 2015, 26(2): 576-579.
16. Aoki R, Hyakusoku H. Pacman flap method. Plast Reconstr Surg, 2007, 119(6): 1799-1802.
17. Oh SH, Kwon H, Kim SJ, et al. Bilateral interdigitated Pacman flap for round and oval facial defects. J Craniomaxillofac Surg, 2018, 46(6): 1032-1036.
18. Sugg KB, Cederna PS, Brown DL. The V-Y advancement flap is equivalent to the Mustardé flap for ectropion prevention in the reconstruction of moderate-size lid-cheek junction defects. Plast Reconstr Surg, 2013, 131(1): 28e-36e.

Chinese Journal of Reparative and Reconstructive Surgery

Repair of eyelid and periocular soft tissue defects with Pacman flap

Abstract Full text Figures/Tables Video References Cited by

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