Full-thickness lower eyelid reconstruction by tarsus-appended orbicularis oculi musculocutaneous island flap
Author: Ken Yamashita
Base Hospital / Institution: Sapporo Medical University School of Medicine / Department of Plastic and Reconstructive Surgery
ePoster presentation
Abstract ID: 24-150
Purpose
Reconstruction of a full-thickness defect of the eyelid is challenging. When the eyelid defect involves more than one-third of the width of the eyelid margin, reconstruction with a skin flap is recommended. Previous reports have used separate reconstruction of the anterior and posterior laminae, which necessarily results in more invasive surgery. Here we report a new flap that combines the orbicularis oculi musculocutaneous (OOM) skin flap with the superior tarsus and conjunctiva, using the excess skin of the upper eyelid.
Methods
The full-thickness defects were 1/3 to 1/2 of the width of the eyelid, including the eyelid margin. The amount of excess skin was measured in the sitting position, and an OOM skin flap was designed at the upper eyelid. The flap was elevated, and a superior-half tarsus and conjunctiva were added under the orbicularis oculi muscle to suit the width of the defect. The width of the harvested tarsus was approximately 4 mm. The flap was moved to the defect, the cranial and conjunctival edges of the skin island were sutured to form the eyelid margin, and the caudal side of the flap was sutured to the lower eyelid retractors. The pedicle of the flap was removed after two weeks.
Results
Three cases were treated with our method, and we achieved favorable results with a sufficient amount of soft tissue for the lower eyelid.
Conclusion
The usual method of reconstruction for full-thickness defects of the lower eyelid is to reconstruct the anterior and posterior laminae separately, but the disadvantage of this method is that it may use tissue other than the eyelid. In our technique, the excess skin of the upper eyelid is used, so the scar is inconspicuous. Even if the tarsus or conjunctiva is harvested, it does not affect the movement of the eyelid. Because the reconstruction is performed with eyelid tissue, ocular complications after reconstruction can be prevented, making this technique useful as a new reconstruction method.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Takatoshi | Yotsuyanagi | Sapporo Medical University School of Medicine / Department of Plastic and Reconstructive Surgery |
| Naohiro | Ueda | Sapporo Medical University School of Medicine / Department of Plastic and Reconstructive Surgery |
| Jiro | Harada | Sapporo Medical University School of Medicine / Department of Plastic and Reconstructive Surgery |
| Asako | Miyabayashi | Sapporo Medical University School of Medicine / Department of Plastic and Reconstructive Surgery |
| Ayaka | Kitada | Sapporo Medical University School of Medicine / Department of Plastic and Reconstructive Surgery |
| Shinji | Kato | Sapporo Medical University School of Medicine / Department of Plastic and Reconstructive Surgery |
