New Orleans–Louisiana State University (LSU) Health Sciences Center in New Orleans will hold a press conference on Monday, April 26, 2004 at 11:30 a.m. (CDT) to announce that Dr. Kamran Khoobehi, a Plastic and Reconstructive Surgeon at Louisiana State University (LSU) Health Sciences Center in New Orleans, has made medical history by reattaching the right upper eyelid that had been ripped off as the dog of a 22-year-old patient snapped at her face and caught her eyelid. A check of the worldwide medical literature and the leading experts in the field, supports the belief that this was the first time an eyelid was successfully microsurgically reattached. If the surgery had been unsuccessful, as the options for a total eyelid reconstruction are very limited, there would have been a high risk of losing her eye due to corneal damage.
Alyssa Kieff, who with her family will participate in the press conference, was rushed to the Emergency Room at West Jefferson Medical Center with the eyelid on April 3, 2004. Home alone when the accident happened, Kieff had the fortitude to retrieve her eyelid and put it on ice, as well as to stay conscious until the paramedics arrived, more than an hour later. LSU Health Sciences Center Plastic Surgeon Dr. Kamran Khoobehi was on call. Khoobehi, who specializes in Microsurgery and Aesthethic Surgery, along with LSU Health Sciences Center Plastic Surgery resident, Dr. Nassif Soueid, set to work to reattach the 1 ½- inch long, ½ wide piece of paper-thin skin, muscle, connective tissue, eyelashes, and glands, with its network of tiny blood vessels. During the six-hour microsurgery, they also reconstructed the tear duct which was traumatized in the accident as well. Using 20 times magnification (the typical magnification at which microsurgery is performed is 4-7 times), the procedure was especially challenging because of the damage inflicted by the violent tearing and the size of the surgical instruments not made for such a delicate procedure. Khoobehi used the thinnest suture material made--11-O--to reconnect the vessels that are about the width of 3-4 human hairs, and even that was nearly as large as the opening of the vessels.
"This was one of the most challenging and rewarding cases that I have had," said Khoobehi. "I was able to help my patient against all odds, and I knew well that if the surgery wasn't successful, in all probability, she would have lost her eye."
Following the surgery, medicinal leeches were applied to the surgical site to drain excess blood and improve circulation in the surrounding area until the reconnected blood vessels were strong enough to function on their own. The leeches were used for four days. The reattached tissue must be closely monitored to determine the degree of success of the procedure, and this takes some time. On day nine post-op, it was determined that this replant was 100% successful, with a total reintegration of the tissue. She was discharged on day ten.
Kieff is able to open and close her eyelid, although there is still a great deal of swelling that makes it difficult for her to hold it open. The eyeball itself was not damaged, and she still has 100% vision in it. The eyelid performs functions critical to eye health and vision–it protects the eye, and tears and periodic blinking cleanse the eye and keep the cornea from drying out. The outer skin of the eye comprises the body's thinnest skin.
"A very talented surgeon, Dr. Khoobehi has been known to attempt the impossible and to achieve it," said Dr. Robert Allen, Chief of the Section of Plastic Surgery at LSU Health Sciences Center in New Orleans. "Hopefully the success of this procedure will help other patients because we now know that it is possible to replant an eyelid."
Kieff's accident happened shortly before Easter, a holiday that holds particular significance for her family. Kieff's husband, Jeramy, had a very bad ATV accident two weeks before Easter in 2000 which hospitalized him for eleven days. Her brother, Jason, was in a bad accident one week later. Understandably nervous about this time of year, perhaps the tide is turning, however. It was on Easter Sunday that Kieff found out that the replant "took" and that her surgery was successful.
Source: Eurekalert & othersLast reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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