wound healing, orbit, eye, eyelid anatomy wound …methods of wound closure primary intention...

Anatomy CourseAnatomy CourseWound healing, orbit, eye, eyelid anatomy Wound healing, orbit, eye, eyelid anatomy including orbital fissures, optic muscles, including orbital fissures, optic muscles,

optic nerve and its relation to the optic nerve and its relation to the paranasalparanasalsinuses. Anatomy of the nose. sinuses. Anatomy of the nose.

Drs. Drs. LaBrunaLaBruna & & JourdyJourdy

Wound HealingWound Healing

PhasesPhasesInflammatory Phase/Coagulation: Inflammatory Phase/Coagulation: neutrophilsneutrophils predominate predominate during the first 24during the first 24--48 hours48 hoursMigratory Phase: macrophages replace Migratory Phase: macrophages replace neutrophilsneutrophils as the as the most prevalent cell type approximately 2most prevalent cell type approximately 2--4 days later4 days laterProliferativeProliferative Phase: collagen formation by fibroblasts Phase: collagen formation by fibroblasts begins around day 3begins around day 3--5 and continues for 25 and continues for 2--4 weeks4 weeksWound remodeling: Around day 21 scar remodeling occursWound remodeling: Around day 21 scar remodeling occurs

Methods of Wound ClosureMethods of Wound Closure

Primary intention Primary intention –– skin edges approximated skin edges approximated using any acceptable closure methodusing any acceptable closure methodSecondary intention Secondary intention –– wound heals via wound heals via epithelializationepithelialization and contractionand contractionThird intention/delayed primary intention Third intention/delayed primary intention ––wound left open for short period of time and wound left open for short period of time and then closed by primary intentionthen closed by primary intentionSkin graft Skin graft –– epidermis + part of dermisepidermis + part of dermisFlaps Flaps –– rotation flap versus free flaprotation flap versus free flap

Factors that Inhibit Wound HealingFactors that Inhibit Wound Healing

Malnutrition (Especially Malnutrition (Especially VitVit C, C, VitVit A, and A, and Zinc)Zinc)SteroidsSteroidsRadiationRadiationSmoking (poor oxygenation)Smoking (poor oxygenation)DiabetesDiabetesAge (Elderly have decreased cell proliferation Age (Elderly have decreased cell proliferation and metabolic activity)and metabolic activity)

OrbitOrbit

Four Walls of the Orbit + ApexFour Walls of the Orbit + Apex

OrbitOrbit

EyelidsEyelids

OrbitOrbit

LacrimalLacrimal ApparatusApparatus

OrbitOrbit

Optic NerveOptic Nerve

Blood supply/drainageBlood supply/drainage

OrbitOrbit

EOMsEOMs

OrbitsOrbits

Orbital FissuresOrbital Fissures

BlepharoplastyBlepharoplasty

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BlepharoplastyBlepharoplasty

Physical ExamPhysical ExamCareful assessmentCareful assessmentProptosisProptosisOphthalmologic examinationOphthalmologic examinationSchrimerSchrimer testtestEvaluation of lower lidEvaluation of lower lid

Snap testSnap testRetraction testRetraction testPinch testPinch test

BlepharoplastyBlepharoplasty

Upper lid Upper lid blephblephLower lid Lower lid blephbleph

TranscutaneousTranscutaneousTransconunctivalTransconunctival

PreseptalPreseptal approachapproachRetroseptalRetroseptal approachapproach

BlepharoplastyBlepharoplasty

ComplicationsComplicationsOrbital hemorrhage and blindnessOrbital hemorrhage and blindnessEctropionEctropionMiliaMiliaLagothalmosLagothalmos

NoseNose

SkeletonSkeleton

NoseNose

Internal Internal Nose: Nose: Medial Medial WallWall

NoseNose

Internal Nose: Lateral WallInternal Nose: Lateral Wall

NoseNose

Blood supplyBlood supplyOphthalmic artery Ophthalmic artery anterior/posterior anterior/posterior ethmoidalethmoidalarteries (superior/middle arteries (superior/middle meatusmeatus, , midnasalmidnasal septum)septum)Maxillary artery Maxillary artery sphenopalatinesphenopalatine artery artery posterior lateral nasal and posterior posterior lateral nasal and posterior septalseptal branchesbranchesMaxillary artery Maxillary artery descending palatine artery descending palatine artery greater palatine artery (lower part of nasal septum)greater palatine artery (lower part of nasal septum)Facial artery Facial artery lateral nasal branch lateral nasal branch superior labial superior labial artery artery septalseptal branchesbranches

RhinoplastyRhinoplasty

Please see Please see handout for handout for additional additional diagrams & diagrams & picturespictures

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