Post Mohs Medial Canthal Defects – Reconstruction Using Dual Flaps
Author: Amelia Davidson
Base Hospital / Institution: Department of Ophthalmology, Greenlane Clinical Centre, Auckland
ePoster presentation
Abstract ID: 25-408
Purpose
The medial canthus is a complex three-dimensional structure comprised of multiple aesthetic subunits. Techniques to reconstruct the medial canthal area are already well-described, and include local flaps or full thickness skin grafts. Traditional glabellar flaps often lead to a cosmetically poor result from mismatch of aesthetic units. Similarly, skin grafts from a distant site have a dissimilar colour and texture, and may fail to adequately address the depth of tissue loss in the medial canthus.
We propose the concept of reconstructing medial canthal defects using dual local flaps from above and below, which minimises tissue distortion, allows for close matching of skin type and is a reliable and safe technique with excellent functional and aesthetic results.
Methods
Patients requiring medial canthal reconstruction following excision of malignant skin cancers were included in the case series. All patients were operated on by the same surgeon (PR). After taking account of the size, depth and location of the defect, a dual flap technique was used for reconstruction. Flaps used in combination included rhomboid rotation flaps and island advancement flaps. Pre-operative and post-operative photography was performed on all patients.
Results
Sixteen eyes of 16 patients with a mean age of 57.7 years (range 42 – 74 years) underwent post-Mohs medial canthal reconstructions between 2020 and 2024. The majority of defects (12 patients, 75%) were reconstructed with a combination of a rhomboid rotation flap from above and a sliding island flap from below. Mean follow-up was 238 days (range 28 – 671 days). Primary closure was achieved in all patients with no observed surgical site infection, wound dehiscence or local tumour recurrence. Excellent cosmetic and functional results were documented in all cases. One patient required injection of 2mg triamcinolone acetonide to reduce flap thickness with a good outcome.
Conclusion
The dual flap reconstruction for medial canthal defects is a versatile technique which provides excellent cosmetic and functional outcomes.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Paul | Rosser | Eyes and Eyelids, Auckland, NZ |
