Reconstruction of Lower Eyelid Defect using Neighboring Remnant Skin

PURPOSE: Facial tumor excision is a common cause of lower eyelid defect in old patients. Many methods have been introduced for the reconstruction of lower eyelid. However, conventional surgical method can cause various complications like scar, ectropion and unnatural color matching. Thus, we introduce a simple and aesthetically acceptable method for the reconstruction of lower eyelid defect. METHODS: Three elderly patients with skin cancer in the unilateral lower eyelid were operated by the new method. Following a wide excision of skin cancer, subcilliary incision of lower blepharoplasty was carried out. Elevated skin flap of lower eyelid was redrapped for the correction of defect and the remnant skin from lateral portion of lower eyelid was used for full thickness skin graft(FTSG) to correct the remaining defect. RESULTS: All grafts survived and color match of the graft was excellent without ectropion. Furthermore, wrinkles of the lower eyelid were improved after the blepharoplasty. CONCLUSION: Lower eyelid defect resulting from wide excision of malignant tumor in old patients could be reconstructed successfully by modifying the conventional lower eyelid blepharoplasty along with FTSG using the remnant skin.

Reconstruction of the Lower Eyelid with Septal Mucochondral Composite Graft and Upper Eyelid Musculocutaneous Flap

Although various procedures for reconstructing the lower eyelid have been reported, their basic principle is always to build a new eyelid that is composed of three elements: an outer cutaneous layer, an inner mucosal layer, and a semirigid supporting tissue between the two layers. Mustarde cheek rotation flap over a chondromucosal graft has been used often to reconstruct the full thickness defect of the lower eyelid. However, Mustarde cheek flap leaves a large unacceptable scar on the face. Therefore we have repaired three cases of lower eyelid defect after resection of the basal cell carcinoma using monopedicled or bipedicled upper eyelid musculocutaneous flap over a septal chondromucosal composite graft. In addition, in case of wide defect including overall tarsal plate, the authors increased indication of mucochondral composite graft by halving method of mucochondral composite tissue. As a result, we made a minimal donor site scar and get the effect of upper blepharoplasty as well by using upper eyelid musculocutaneous flap. Based on follow-ups of 10 to 19 months, the functional and aesthetic results were found to be good in all cases. This procedure may be applicable for total or subtotal reconstruction of the lower eyelid.