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

ABSTRACT

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.