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A technique for the reconstruction of lower eyelid marginal defects

Objectives: To report on a new one-step technique for the reconstruction of lower eyelid marginal defects. Method: Retrospective case series of 5 patients with lower eyelid basal cell carcinomas abutting the eyelid margin. In all patients, the tumour was radically excised with a 3-mm clear cutaneous margin and a 2-mm tarsoconjunctival margin under frozen section control. Defect size ranged from 12 to 22 mm horizontally and from 8 to 9 mm vertically. For eyelid reconstruction, the 2-mm residual lower lid tarsus was advanced superiorly on a conjunctival pedicle and sutured into the posterior lamella defect. The anterior lamella was reconstructed with orbicularis muscle advancement and a free skin graft from the ipsilateral upper eyelid. The outcome following surgery was assessed using a subjective scoring system with 4 subsequent grades (poor, adequate, good, excellent). Results: At 1 week postoperatively, adequate viability of the grafts was noted in all patients. One patient developed transient punctate epithelial keratopathy. After a mean follow-up of 10 months (range 1 to 21 months) the outcome was “poor” in 0 patients, “adequate” in 0 cases, “good” in 1 case and “excellent” in 4 cases. Conclusion: Reconstruction of small to large lower lid marginal defects with local tarsoconjunctival flap advancement combined with orbicularis muscle advancement and free skin graft is associated with a good functional and cosmetic outcome and limited donor-site morbidity.