The Hughes procedure is a standard and widely used technique for lower eyelid reconstruction. This paper presents the results of 55 patients who underwent reconstruction of the anterior and posterior lamella with the Hughes procedure at the University eye clinic in Salzburg between 2002 and 2012. This study included 55 patients who underwent lower eyelid reconstruction performed with the Hughes procedure including a full skin graft. In 95 % of patients (52/55) this method was performed after tumor resection. The defect size of the lower lid was at least 10 mm horizontally and ranged between 10 and 15 mm. Of the patients three were treated with a combined Hughes and Tenzel procedure whereas in five cases the Hughes procedure was combined with an autologous tarsoconjunctival flap of the contralateral upper lid and a local full skin rotational flap. In 42 out of 55 patients both the eyelid function as well as the restoration of good cosmesis could be achieved. In 6 out of the remaining 13 patients suffering from minor complications, the function and cosmesis were restored after secondary minor surgery or additional conservative treatment. For six patients, further reconstructive surgery was necessary and one experienced a major complication in the form of a recurrence of basal cell carcinoma necessitating exenteration. The Hughes procedure is a well-suited technique for eyelid reconstruction of shallow defects extending beyond 10 mm horizontally and involving up to 100 % of the eyelid. The latter require a combined procedure such as the Hughes procedure and an autologous tarsoconjunctival flap and skin graft.

BACKGROUND:Mucosal grafts from the hard palate for reconstruction of the posterior lamella of the upper eyelid were compared for three different indications. The plastic reconstruction of the upper eyelid was carried out in patients with symblepharon and upper eyelid entropion following an autoimmune disease, in patients with subtotal or total upper eyelid resection due to a neoplasm and in patients with mucous membrane trauma using autogenous mucosal grafts from the hard palate. PATIENTS:In this retrospective comparative interventional case series 23 eyes from 19 patients were included in whom upper eyelid reconstruction was undertaken at the University Eye Hospital in Salzburg between 2001 and 2012. Reconstruction with hard palate grafts was performed in 5 eyes following extensive tumor resection, in 5 eyes of 3 patients after autoimmune diseases and in 13 eyes of 11 patients following trauma rehabilitation. RESULTS:In the total collective of patients who underwent upper eyelid reconstruction with hard palate grafts, no graft rejection or loss of graft occurred. Hard palate grafts are useful for reconstruction after tumor surgery in addition to other techniques in order to achieve good functional and esthetic results. For patients suffering from autoimmune disease (e.g. ocular pemphigus and Stevens-Johnson syndrome) the use of hard palate grafts was found to be equally useful, although results can possibly deteriorate over time due to the underlying disease. Hard palate grafts were shown to be very useful in reconstruction of the upper eyelid for correction of entropium due to symblepharon and distichiasis following thermal and chemical burns. CONCLUSION:Hard palate grafts are suitable as mucosal grafts replacing conjunctiva in systemic disease and are equally effective in the treatment of traumatic upper eyelid defects - such as defects after tumor surgery.

Background: The aim of this study was to describe the efficiency, long-term success, patient satisfaction and recurrence rate after dacryocystorhinostomy according to Toti in a retrospective analysis.Material and Methods: At the Eye Clinic of the Paracelsus Medical University Salzburg 188 eyes of 176 patients with stenosis/obstruction of lacrimal duct were surgically treated between January 2000 and December 2012. Of these patients 173 eyes had no surgery before DCR according to Toti and 15 eyes had already been operated with diverse dacryocystorhinostomies. All patients underwent dacryocystorhinostomy according to Toti. Pre- and postoperative clinical finings were analysed retrospectively. Postoperative long-term results regarding patient satisfaction, absence of inflammation, epiphora and annoyance through local scar building had been evaluated with a questionnaire in a cross-sectional analysis.Results: The primary success rate of DCR according to Toti was 91,9% and the secondary success rate 98,3% in patients without surgery preoperatively. Classifying by localisation of stenosis, better results could be reached in patients with postsaccal stenosis/obstructions (94,3%) than in those with presaccal obstructions (77,8%) or with mixed pre- and postsaccal stenosis/obstructions (86,7%). Also in the patient group with previous surgery primary and secondary success rates of 93,3% could be achieved after DCR according to Toti.Conclusion: This study confirms that DCR according to Toti is a highly successful technique minimising epiphora and discomfort. The best success rate was found in patients with postsaccal stenosis/obstructions. The local scar was not found to be disturbing.

Schleimhauttransplantate vom harten Gaumen zur Rekonstruktion der hinteren Lidlamelle des Oberlides wurden bei 3 unterschiedlichen Indikationsstellungen verglichen. Die plastische Rekonstruktion des Oberlides erfolgte bei Patienten mit Symblepharon und Oberlidentropium nach Autoimmunerkrankung, bei Patienten nach subtotaler und totaler Oberlidresektion bei Tumoren sowie bei Patienten mit Schleimhauttraumata mittels Schleimhauttransplantat vom harten Gaumen.

Die Operation nach Hughes gilt als etabliertes Verfahren zur Unterlidrekonstruktion. Die vorliegende wissenschaftliche Studie stellt die Ergebnisse der Rekonstruktion der vorderen und hinteren Lidlamelle durch die Hughes-Plastik und darüber hinaus Ergebnisse von damit kombinierten operativen Verfahren an einem Zentralkrankenhaus von 01/2002 bis 03/2013 vor.