Purpose

To present a case series of three patients with complicated lower eyelid ectropion that developed after basal cell carcinoma excision and to highlight the main reconstructive principles for its successful management.

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Methods

We reviewed three cases of complicated lower eyelid ectropion after eyelid reconstruction due to basal cell carcinoma excision.

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Results

Three patients with complicated lower eyelid ectropion were treated surgically.
A 68-year-old man presented with complicated ectropion that developed after direct closure of the defect with local tissue, resulting in vertical traction. Reconstruction was performed using an ipsilateral upper eyelid graft and Frost traction suture.
A 71-year-old woman presented with secondary ectropion after direct defect closure with local skin. Reconstruction was performed using a local skin flap (Tenzel flap) and Frost traction suture.
A 56-year-old woman developed iatrogenic ectropion after transpositional flap reconstruction, which created significant vertical traction. Reconstruction was performed using two grafts from both upper eyelids.

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Conclusion

In all cases the primary cause of ectropion was vertical tissue traction in the reconstruction area. The key principles of prevention and treatment of complicated ectropion are avoidance of vertical traction and horizontal tissue redistribution. Successful management requires careful individual evaluation of the defect in order to choose the most appropriate reconstructive technique, including local flaps, skin grafts, or combined techniques.

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Additional Authors

First name	Last name	Base Hospital / Institution
Artur	Klett	East Tallinn Central Hospital
Anatolijs	Požarskis	Daugavpils University

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