Experience in Upper Eyelid Reconstruction With the Cutler-Beard Technique

Abstract

Reconstruction of full-thickness upper eyelid defects has to supply a movable lid with perfect corneal protection, good aesthetic quality, and acceptable sequelae at the donor site. The Cutler-Beard procedure, a full-thickness cutaneoconjunctival inferior eyelid advancement flap, is a reliable method for reconstruction of total or partial upper eyelid defects. Especially in older individuals, the skin of the donor site is loose and provides sufficient tissue to stretch. Color and texture of the donor matches the recipient site perfectly. Destabilization or ectropion of the donor site, the lower lid, and retraction or entropion of the recipient site, the upper lid, are the main complications. Therefore, a modification of the classic technique should be considered by implantation of an enforcing inlay in the reconstructed lid (eye bank sclera, fascia lata, ear cartilage), especially in reconstruction of extended defects of the upper lid.

A Modified Cutler-Beard Technique to manage Extensive Sebaceous Gland Carcinoma of Upper Eyelid

“…Cutler-Beard technique was proposed in year 1955 as a viable surgical option for upper lid reconstruction. 8 It is based on the concept of lower lid sharing. Its major disadvantage was insufficient transfer of tarsus to upper lid causing a floppy lid formation.…”

Apocrine hidrocystoma of eye lid mimicking as sebaceous cell carcinoma

“…The differentials for this tumor are nevi, basal cell carcinoma, melanoma, milia and syringomyelia. The patient had a pinkish, fleshy lesion resembling sebaceous gland carcinoma which is a malignant lesion for which he underwent excision of tumor followed by Cutler-Beard reconstruction [4]. …”

Pedicled lower lid-sharing flap for full-thickness reconstruction of the upper eyelid

“…These include prolonged occlusion of one eye, persistent lower eyelid instability, no lash restoration, no smooth eyelid margin, different color, thickness and character, risk of lid ectropion, and compromising lower eyelid integrity and stability. 3,4 The temporal forehead flap (Fricke) has the advantage of reconstruction of large anterior lamella defects; however, it is limited in that it requires posterior lamella coverage, requires removal of some original skin, the lack of eyelashes and eyebrows, which compromises lower eyelid integrity and stability, different color and thickness, no lash eyelid margin, and often needs a two-stage procedure. 5,6 The semicircular rotational flap (Tenzel) also requires that the conjunctiva is undamaged; it has several limitations, such as no lash eyelid margin and the lack of eyelashes.…”