Repairs of Large Defects of the Lower Lid and the Infraorbital Region With Suspended Cheek Flaps With a Dermofat Flap

Surgical Strategies for Eyelid Defect Reconstruction: A Review on Principles and Techniques

Reconstruction of eyelid defects, especially the posterior lamella, remains challenging because of its anatomical complexity, functional considerations, and aesthetic concerns. The goals of eyelid reconstruction include restoring eyelid structure and function and achieving an aesthetically acceptable appearance. An in-depth understanding of the complex eyelid anatomy and several reconstructive principles are mandatory to achieve these goals. Currently, there are multiple surgical treatment options for eyelid reconstruction, including different flaps, grafts, and combinations of them. This comprehensive review outlines the principles of reconstruction and discusses the indications, advantages, and disadvantages of currently available surgical techniques. We also propose our clinical thinking for solving specific clinical questions in eyelid reconstruction and offer perspectives on new potential methodologies in the future.

Eyelid reconstruction and infraorbital repair using a Mustardé flap technique in a dog

This case report describes a 5-year-old dog with a defect in the right eyelid, absence of orbicularis musculature, and absence of cutaneous tissue in the infraorbital region, submitted to the Mustardé flap technique. A large rotational flap was performed, including a cartilage graft from the outer ear, to correct the defect in the lower eyelid and infraorbital region. Also, euryblepharon correction of the upper eyelid was performed with wedge excision. The techniques were performed in a single surgical step and with appropriated functional and aesthetic results. The described approach may be employed as a surgical option in large eyelid defects.

Lower Eyelid Reconstruction Using a Nasolabial, Perforator-based V-Y Advancement Flap: Expanding the Utility of Facial Perforator Flaps

BACKGROUND

Reconstruction of the lower eyelid represents a unique challenge to the reconstructive surgeon. Studies evaluating the utility of the nasolabial V-Y advancement flap in lower eyelid reconstruction are limited and techniques to optimize outcomes following eyelid reconstruction with this technique are not well described. We seek to evaluate our experience and outcomes with lower eyelid reconstruction using the nasolabial perforator-based V-Y advancement flap.

METHODS

After institutional review board approval, medical charts of all patients who underwent lower eyelid reconstruction using the nasolabial perforator-based V-Y advancement flap between February 2013 and October 2017 were reviewed. Data regarding etiology, location of the lesion, lower eyelid defect, methods of reconstruction, postoperative complications, and follow up duration were collected and analyzed.

RESULTS

Over the study period, 5 patients (3 male) underwent lower eyelid reconstruction after oncologic resection of melanoma (n = 1) and nonmelanoma (n = 4) skin cancer using the nasolabial perforator-based V-Y advancement flap at a mean age of 69 years (range, 56-82 years). Median follow-up duration was 5.9 months (interquartile range, 2.25-25.9). A mean of 5.4 (range, 2-10) perforators were included in the initial flap design. After completion of flap dissection and perforator division, a mean of 4.4 (range, 2-7) perforators were preserved and included in the flap. All flaps demonstrated clinical viability with no cases of partial or total flap loss. One patient developed an asymptomatic ectropion during the follow-up period.

CONCLUSIONS

The nasolabial, perforator-based V-Y advancement flap is a reliable reconstructive method for lower eyelid defects.