NYMC Faculty Publications

Lower Eyelid Reconstruction Practice Patterns Among U.S. Oculoplastic Surgeons

Author Type(s)

Faculty

Journal Title

Investigative Ophthalmology and Visual Science

First Page

1083

Last Page

A0178

Document Type

Abstract

Publication Date

6-2022

Department

Ophthalmology

Abstract

Purpose : There is no accepted standard of care for the reconstruction of full-thickness lower eyelid defects unable to be repaired by semicircular flaps or primary closure. We present a cross-sectional study of the preferred practice patterns and reconstructive techniques for these defects among U.S. oculoplastic surgeons surveyed 01/2021–03/2021.

Methods : We designed a survey to determine surgeon use and preference for the modified-Hughes procedure, transposition/advancement flap with free tarsal graft, Mustarde flap, bipedicle flap plus free tarsal graft, and free tarsal graft with free skin graft when treating lower eyelid defects. 596 oculoplastic surgeons who completed an oculoplastics fellowship were contacted by email or Doximity messenger. Contact information was obtained via practice and hospital websites, and the corresponding author section of Ophthalmic Plastic and Reconstructive Surgery. Retired physicians and pure cosmetic surgeons were excluded. Pearson chi-square testing compared surgical techniques and respondent demographic data.

Results : 120 surgeons responded (20.1%) with no statistically significant differences in response rate across U.S. regions. Median age range was 41-50 years (29.1%), with most respondents aged 70 or less. The majority of surgeons were in practice for 1–10 years (35.8%), with only 7 surgeons practicing for >40 years. Group practice was the most common practice setting (44.5%). The modified-Hughes procedure was the most common technique (92.5%), followed by the transposition/advancement flap with free tarsal graft (52.5%) and then the Mustarde flap (40.8%). The free tarsal graft with free skin graft was the least commonly used technique (8.3%). Most surgeons performing the Hughes and transposition flap techniques were in their first 20 years in practice (63.1%, 55.6%). The bipedicle flap with free tarsal graft was more common in academics (16 patients) and group practices (8) than solo practices (6). Middle-aged surgeons were more likely to perform free tarsal grafts with free skin grafts (70.0%) than other age groups.

Conclusions : While U.S. oculoplastic surgeons use various techniques for repair of full-thickness lower eyelid defects, the Hughes procedure was the most common in this study. Further quantitative examination is necessary to determine physician justification for technique preference.

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