Ergebnisse der Operation nach Hughes

Zusammenfassung

Hintergrund. Bei der Rekonstruktion großer Liddefekte wird in ca. 7–10% die totale bzw. partielle Lidneubildung mit der Hughes-Operation erzielt. Wir berichten über die Ergebnisse der Hughes-Operation in einem 10-jährigen Zeitraum.

Patienten und Methoden. Von 610 operierten Lidbasaliomen und -karzinomen wurden 60 sowie ein großer traumatischer Oberliddefekt mit der Originalmethode nach Hughes versorgt. Von 55 Patienten konnten die postoperativen Befunde analysiert werden.

Ergebnisse. Es wurden 50 von 54 Tumoren in sano, 4 nicht in sano entfernt, 1-mal Oberlidneubildung nach Trauma. In 86% war der postoperative Verlauf regelrecht. Als Frühkomplikationen traten geringe Wunddehiszenz, Transplantatabstoßung, arterielle Blutung, Wundinfektion und Hornhautinfiltrat auf. Spätkomplikationen waren Rezidivtumor, Wimpernepilation, Entropiumoperation. Minorkomplikationen bestanden in Distiachiasis, Lidrandkerben, kleinerer Lidspalte, inkomplettem Lidschluss. Die kosmetischen Ergebnisse waren zufrieden stellend.

Schlussfolgerungen. Für die Rekonstruktion großer Liddefekte ist mit der Hughes-Operation ein gutes therapeutisches, funktionelles und kosmetisches Ergebnis zu erzielen. Die modifizierte Hughes-Operation ist wegen der geringeren Komplikationsrate zu bevorzugen.

Abstract

Background. There are several methods for the repair of large defects of the upper and lower eyelids, but we prefer the original procedure by Hughes. This operation has been used traditionally for partial and total reconstruction of lid defects after tumour resection in 7–10%. The advantage of this technique is the rebuilding of the eyelid with the lid tissue itself. We present the results of operations by the Hughes method over a 10-year-period.

Patients and methods. Between 1986 and 1996 we operated on 60 out of 600 patients with neoplastic tumours of the eyelids and 1 patient with a large traumatic defect of the upper eyelid by the original operation method of Hughes. We report on a retrospective study of 55 patients including30 males and 25 females with a mean age of 68.6 years. The duration of the histories of the tumours ranged from 2 month to 10 years. The lower eyelids were involved in 46 patients and the upper lids in 9. In 80% (45 patients) we found basal cell carcinomas and in 17% (9 patients) squamous cell carcinomas.

Results. Therapy of tumours: 50 out of 54 tumours (92.6%) were resected in sano and 4 not. During the dissection of the lids we carried out a tissue biopsy but no further tumour tissue was found in three patients. The fourth patient needed three further operations before recovery. In six patients we recognised a new tumour, one of them suffered from Lewandowsky-Lutz-Syndrom, developed a new tumour in the orbit andrequired exenteration orbitae. Early complications: arterial bleeding in one case, in four cases mild dehiscence of the wound between the graft and the remaining lid, in two patients with high risk, infection of the wound, one rejection of the skin graft, one small infiltration of the cornea. Late complications: In six cases we recognised recurrence of the tumour and three patients with entropium and seven patients with heavy trichiasis needed revision. Minor complications such as mild distichiasis, partial incomplete closing of the lids, a smaller lid fissure or notching of the canthus of the lid which did not require revision. The results were quite satisfactory from a functional and aesthetic point of view.

Conclusions. We recommend the operation method of Hughes for reconstruction of large defects of the eyelids of any reason.