Reconstruction of lateral eyelid defects using combination Hewe and Tripier flaps
Author: YVONNE CHUNG
Base Hospital / Institution: SINGAPORE NATIONAL EYE CENTRE
ePoster presentation
Abstract ID: 25-520
Purpose
Combination Hewe and Tripier flaps should be added to the surgical armamentarium of techniques used to construct lateral eyelid defects post tumour resection
Methods
3 cases of eyelid reconstruction using combination Hewe Tripier flaps are described for the following post MOH’s micrographic surgical resection.
Case 1: 64 year old Caucasian male with basal cell carcinoma involving lateral third of lower lid. Islands of facial cancer remain which were subsequently treated with PDT (photodynamic therapy)
Case 2: 68 year old Chinese male with basal cell carcinoma involving lateral half of lower lid
Case 3: 50 year old Chinese male with endocrine mucin-producing salivary gland carcinoma (EMPSGC) involving lateral third of lower lid
Hewe’s: tarsoconjunctival flap harvested from the upper lid, rotated downward to bridge the lower lid posterior lamella defect and sutured to the medial tarsus and lower lid retractors with 6.0 vicryl.
Trippier flap: Myocutaneous flap harvested from the upper lid for the anterior lamella defect. Skin closure with 6.0 ethilon
Results
Flaps remained healthy viable in all cases. No evidence of dehiscence or necrosis. Scar retraction with mild anterior lamella shortening was seen for case 1 and 3 with rounding of the lateral canthus. There was no lagopthalmos in all 3 cases. Cosmetic outcomes remained good.
Conclusion
Lateral eyelid defects involving 50% or less of the eyelid length may be addressed with Tenzel sliding flaps. While it provides good anterior lamella defect coverage, there can be lack of posterior lamella support laterally. Also suboptimally fashioned flaps may result in lateral lid ectropion.
Standalone Hewe’s tarsoconjunctival procedure and Tripier myocutaneous flaps are not new techniques. However, combining both techniques provides an alternative to Tenzel flaps for lateral eyelid defect reconstruction. The advantages of using combination flaps include lateral eyelid posterior lamella support (Hewe’s) and cosmesis. These combination flaps may also be of use in younger patients with minimal lateral facial skin laxity which may limit the use of Tenzel sliding flaps.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Choon Chiat | Oh | Singapore General Hospital |
