Surgical Management of Cicatricial Palpebral Ectropion Following Burns and Tumors: A Retrospective Study of 39 Patients in a Moroccan Tertiary Center

Abstract: Background: Cicatricial palpebral ectropion is a frequent and functionally disabling sequela of facial burns, tumor surgery and other eyelid injuries, particularly in low‑ and middle‑income settings where acute care and scar management can be suboptimal. Surgical correction aims to restore eyelid–globe apposition, protect the ocular surface, and improve cosmesis, but optimal strategies remain debated. Methods: We conducted a retrospective descriptive study including all consecutive patients operated for palpebral ectropion in the plastic surgery department of Mohammed VI University Hospital, Marrakech (Morocco), between January 2020 and December 2023. Inclusion criteria were: clinically diagnosed palpebral ectropion, complete ophthalmologic assessment, and definitive surgical treatment in the unit; patients without surgery or with incomplete records were excluded. Demographic data, etiologies, clinical presentation, operative techniques, postoperative course, complications, recurrence and patient-reported satisfaction were extracted from hospital registers, medical files, operative notes and ophthalmology reports, and analyzed descriptively using Microsoft Excel. Results: Thirty‑nine patients were included; mean age was 43.8 years (range 6–86) with a male predominance (59%; n=23). Most patients resided in urban areas (74.3%) and two‑thirds had some form of medical coverage. All ectropions were cicatricial: 64.1% followed burns (predominantly thermal) and 30.7% tumor surgery; minor facial trauma accounted for 5.1%. The main presenting symptoms were tearing (43.6%), functional discomfort (41%), foreign‑body sensation (25.6%) and conjunctival hyperemia (25.6%); 25.6% reported decreased visual acuity and 20.5% had keratitis, while two patients (5.1%) had corneal ulceration. Ectropion was unilateral in 74.3% and bilateral in 25.7%; the lower eyelid alone was involved in 53.8%, the upper eyelid alone in 18.0%, and both lids in 28.2%. All patients underwent cicatricial release under general anesthesia: 76.9% via a fish‑tail incision, 20.5% via a linear incision and 2.6% via Z‑plasty. Anterior lamella reconstruction used full‑thickness skin grafts in 89.7% of cases, and local flaps (Mustardé, Tenzel, Tripier) in 2.6% each; one patient also required conjunctival reconstruction. Early postoperative complications were infrequent: 85% of patients had an uncomplicated course, 5% had partial graft loss and 10% developed local infection, without hematoma, flap necrosis or graft failure. Recurrence of ectropion occurred in three patients (7.7%) during follow‑up. Overall satisfaction was high: 81% of patients were very satisfied, 11% satisfied and 8% not satisfied with the functional and aesthetic outcome. Conclusion: In this burn‑ and tumor‑predominant North African cohort, cicatricial ectropion affected relatively young patients and was effectively managed by systematic scar release combined with full‑thickness skin grafting in nearly 90% of cases, with low complication (15%) and recurrence (7.7%) rates and a high level of patient satisfaction. These findings support full‑thickness skin grafting as a robust first‑line reconstructive option for extensive cicatricial anterior lamella deficiency, while highlighting the need for early burn care and long‑term follow‑up in high‑risk populations.