Purpose

To assess the outcomes of the Hughes tarsoconjunctival flap for reconstruction of full-thickness lower eyelid defects following tumour excision.

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Methods

A multicentre retrospective study was conducted at two tertiary oculoplastic referral centres, including consecutive patients who underwent lower eyelid reconstruction with a Hughes tarsoconjunctival flap between July 2018 and March 2025. Inclusion criteria were full-thickness lower eyelid defects involving at least 50% of the horizontal eyelid length after tumour excision. Patients with follow-up shorter than 12 months, orbital invasion requiring exenteration, or incomplete records were excluded. Frozen sections were used in all cases to confirm complete tumour excision. Data collected included demographics, histology, defect characteristics, lacrimal system involvement, reconstructive techniques, complications, reinterventions and follow-up. Functional and aesthetic outcomes were graded on a 5-point scale.

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Results

Eighty-four patients were included (46 male, 38 female), with a mean age of 78.1±11.7 years. Basal cell carcinoma accounted for 91% of tumours, squamous cell carcinoma for 5%, and other malignancies for 4%. Mean defect width was 14.6±4.9 mm. Anterior lamellar reconstruction was performed with myocutaneous flaps in 73.7% of cases, free skin grafts in 10.5%, and combined techniques in 15.8%. Lacrimal system involvement was present in 11.8%. Mean follow-up was 48.6 months. Complications occurred in 22.9% of cases and were predominantly mild to moderate. Functional and aesthetic outcomes were excellent or good in 82.9%, satisfactory in 15.8%, and poor in 1.3%. No local recurrences were observed.

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Conclusion

Although non-bridging techniques are generally preferred for large lower eyelid defects, the Hughes bridge flap remains valuable for extensive horizontal defects. Additional surgery is seldom required. In medial defects, a skin graft may reduce the risk of medial ectropion even when local tissue appears adequate. Alternative techniques should be considered following excision of highly malignant tumours.

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Additional Authors

First name	Last name	Base Hospital / Institution
Claudia	Pirro	Oftalmoplastica Roma – Rome, Italy
Nicola	Santoro	Unit of Ocular Oncology, Dept. of Surgery and Translational Medicine, Careggi University Hospital – Florence, Italy
Claudio	Esposito	Unit of Ocular Oncology, Dept. of Surgery and Translational Medicine, Careggi University Hospital – Florence, Italy
Cinzia	Mazzini	Unit of Ocular Oncology, Dept. of Surgery and Translational Medicine, Careggi University Hospital – Florence, Italy
Francesco	Quaranta Leoni	Adnexal and Orbital Service – Tiberia Hospital, GVM Care & Research – Rome – University of Ferrara – Italy

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