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Repair of an Extensive Defect of the Medial Canthus.

A56-year-old man with a history of renal transplant presented for treatment of a recurrent infiltrative basal cell carcinoma affecting the left medial canthus and extending onto the medial lower eyelid. This had initially been treated with Mohs micrographic surgery at an outside institution 2 years before, at which time the patient had been referred for oculoplastic repair but was lost to follow-up. The wound had healed by granulation, resulting in severe ectropion of the lower eyelid (Figure 1A). The recurrent tumor was removed with 2 stages of Mohs micrographic surgery, resulting in a full-thickness defect of the left medial lower lid, in addition to skin and muscle of the nasal sidewall and medial upper eyelid (Figure 1B). How would you repair this defect?