Large full thickness medial canthal reconstruction: a report of two cases and review of literature

The reconstruction of the upper eyelid with medial canthal involvement post extensive removal of malignant tumour remains a challenge. Proper eyelid reconstruction is necessary to re-establish anatomic integrity, restoration of its functions and to maintain the best cosmetic appearance. These case reports illustrate an alternative reconstructive technique for large upper eyelid full thickness defect with medial canthal involvement. Two cases of upper eyelid tumours involving medial canthal region underwent staged reconstruction by glabellar flap advancement and reconstruction of the posterior lamellar with autologous graft using buccal mucosa and ear cartilage. The posterior lamellar graft and flap survived without any complication except for mild eyelid margin notching in one of the two cases. The staged reconstruction with glabellar flap advancement provides adequate defect coverage, excellent blood supply, maintains eyebrow contour and function of the eyelid. The flap also perfectly matches the surrounding tissue with minimal donor site morbidity.

Upper Eyelid Reconstruction Using the Medpor(R) Sheet and Median Forehead Flap

PURPOSE: To report the upper eyelid reconstruction with median forehead flap and Medpor(R) sheet implant following full-thickness eyelid defect resulting from tumor resection. CASE SUMMARY: A 65-year-old woman was examined at our hospital for a recurrent mass on the right upper eyelid. A wide tumor excision with a 3 mm margin and an eyelid reconstruction procedure were performed after a frozen section biopsy revealed a malignancy. The full-thickness eyelid defect was reconstructed with a median forehead flap as a substitute for skin and muscle and a Medpor(R) sheet substituted for tarsal plate was sutured with a lower conjunctiva flap for posterior lamella. The histopathology diagnosis of the lesion showed a well-differentiated squamous cell carcinoma. The lower conjunctiva was separated at 2 weeks after surgery, and then the median forehead flap detached from the upper eyelid skin at 8 weeks after surgery. One year postoperatively, there was no evidence of a wound infection and an exposure of the Medpor(R) sheet. The eyelid had a good cosmetic contour and the movement of the eyelid during blinking was natural. CONCLUSIONS: The use of a Medpor(R) sheet as a substitute for a tarsal plate in reconstructive procedures of the upper eyelid defect shows cosmetic and functional success.

Reverse Modified Hughes Procedure for Reconstruction of Upper Eyelid

PURPOSE: The purpose of this article is to describe reverse modified Hughes procedure to reconstruct extensive full-thickness defect developed on over 75% of the upper eyelid. METHODS: We performed upper eyelid reconstruction on 4 patiets with extensive full-thickness upper eyelid defect more than 80% due to tumor resection. A tarsoconjunctival flap from a donor lower eyelid reconstituted the posterior lamella, orbicularis oculi muscle was mobilized over the tarsoconjunctival flap, and an advanced redundant cutaneous flap adjacent to the eyelid defect were used to reconstruct the anterior lamella. Tarsoconjunctival flap splitting was performed 6 weeks later. Follow up ranges from 6 months to 5 years. RESULTS: We obtained satisfactory results on all 4 patients both clinically and cosmetically. There have been no complications such as ectropion, lower-lid necrosis. CONCLUSIONS: Reverse modified Hughes procedure is an ideal option for reconstruction of extensive fullthickness upper eyelid defect.