PMC7775522_01
(A) Severe skin defect and necrotic debris. (B) Dorsolateral strabismus before surgical correction.
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F1
However, along the left lateral maxilla, the external skin and middle part of the sphincter colli profundus pars intermedia muscle were exposed (Figure 1A). Ocular examination of the left eye revealed moderate periocular swelling, conjunctival injection, and severe dorsolateral globe displacement with mild exophthalmos (Figure 1B).
Surgical and schematic images of the strabismus repair. (A) Image of the initial ocular damage with the torn medial canthus muscle and sclera. (B) Schematic image of (A). (C) Image of the sutures placed in the longitudinally split partial DRM and SIS patches above the torn area. (D) Schematic image of (C). DRM, dorsal rectus muscle; MRM, medial rectus muscle; LRM, lateral rectus muscle; VRM, ventral rectus muscle; SIS, small intestine submucosa.
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F2
The MRM was not found to be damaged, but the sclera under the muscle was found torn, preventing a direct suture (Figures 2A,B). Then the DRM was split longitudinally, transposed in the direction toward the SIS, and interrupted sutures were placed using 6-0 Vicryl (coated vicryl; Ethicon) (Figures 2C,D).
Reconstructive surgery of the facial skin defect. (A) Severe skin defect and necrotic debris before surgery. (B) The local subdermal plexus rotation flap at surgery.
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F3
A local subdermal plexus rotation flap, 10 cm wide and 22 cm long, was applied (Figure 3A). The flap was sutured into the recipient site using 3-0 nylon in a simple interrupted pattern at the skin edges, and a Penrose drain was placed under the flap (Figure 3B).
The changes of the flap after surgery. (A) Viability of the flap 1 day after surgery. (B) The conditions of the skin flap and globe 18 days after surgical correction. (C) The condition of the skin flap 21 days after surgery.
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F4
One day after the surgery, the subdermal plexus flap was viable, and the tarsorrhaphy appeared intact (Figure 4A). Although the globe was located in a slightly dorsolateral position, the ocular malposition was improved (Figure 4B). Some sutures at the flap and donor site were removed 21 days post-operatively (Figure 4C).
(A) The corneal condition 21 days after surgery. (B) The corneal condition 7 weeks after surgery. (C) The corneal condition 1.5 years after surgery. (D) Globe positions of both eyes 1.5 years after surgery.
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F5
OU, but a corneal ulcer with superficial and deep neovascularization was noted (Figure 5A). On ophthalmologic examination OS, Schirmer The corneal ulcer was healing with normal STT and IOP (Figure 5B). At the final follow-up examination 1.5 years after surgery, the chronic scar on the cornea and pigmentation at the medial canthus remained (Figure 5C). At the follow-up 1.5 years after surgery, the globe position was near normal (Figure 5D).