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Review paper

Correlation between clinical outcomes and patients’ satisfaction using tarsoconjunctival - Hughes flap for the reconstruction of eyelid defects

By
Nina Jovanović Orcid logo ,
Nina Jovanović
Contact Nina Jovanović

Ophthalmology Department, Canton Hospital Zenica, Zenica, Bosnia and Herzegovina

School of Medicine, University of Zenica, Zenica, Bosnia and Herzegovina

Patricia Reisz-Majić ,
Patricia Reisz-Majić

Eye Clinic, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia

University Hospital Centre Osijek, Osijek, Croatia

Sunita Mehic-Fazlić ,
Sunita Mehic-Fazlić

Otorhinolaryngology Department, Canton Hospital Zenica, Zenica, Bosnia and Herzegovina

Selma Terzić ,
Selma Terzić

Sarajevo Canton Emergency Medical Service, Sarajevo, Bosnia and Herzegovina

Jasmina Alajbegović Halimić ,
Jasmina Alajbegović Halimić

Private Ophthalmology Practice, “Dr. Halimić”, Sarajevo, Bosnia and Herzegovina

Admira Dizdarević
Admira Dizdarević

Ophthalmology Department, Cantonal Hospital Zenica,

Abstract

Aim
To examine and quantify patients’ satisfaction and correlate with the objective clinical presentation after the treatment and to present a comprehensive literature review on tarsoconjunctival/Hughes flap technique.
Methods
A review of more than 159 peer-review articles and a combined retrospective-prospective two-centres case series of 17
patients who underwent a two-stage modified Hughes flap procedure (2019-2021) to repair a lower eyelid defect caused by epithelial cancer was conducted. All patients were followed up for a minimum of six months. Patient macroscopic evaluation of redness, lid position, retraction, trichiasis, conjunctival overgrowth, tissue inflammation/infection and hypertrophic scarring were obtained, and findings were graded on a scale of 1 to 5 or binary YES/NO
scale. Patients’ satisfaction using a Likert-type scale and correlation with the clinical presentation were analysed.
Results
Pearson correlation coefficient between patients’ satisfaction and clinical presentation was 0.534. Out of 510 (the highest
summed score for patients’ satisfaction), the total score was 479 (93.9%); out of 187 (the highest summed score for clinical presentation), the total score was 162 (86.6%). Although both scores were high, a lower correlation coefficient and the higher satisfaction score can be explained by more realistic expectations in oncological patients compared to cosmetic ones.
Conclusion
Hughes flaps provide multiple benefits in the reconstruction of selected patients with large defects, especially when
poor wound healing is expected, or when local advancement flaps do not provide tension-free reconstruction. The rate of complications is low and manageable, whereas additional therapy is usually observational or symptomatic. 

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