Laterally Based Orbicularis Oculi Myocutaneous Flap: Revisiting for the Secondary Ectropion Correction

Abstract

Background: The management of lower eyelid ectropion is considered a challenge. Lower eyelid ectropion is conventionally reconstructed with a full-thickness skin graft or a local flap. However, complications as scar contracture and the recurrence of ectropion frequently occur. This article describes an effective surgical technique for ectropion correction using an upper eyelid as the laterally based orbicularis oculi myocutaneous flap. Methods: The flap was used in 7 patients who were subjected to lower eyelid reconstruction. A strip of unipedicled orbicularis oculi myocutaneous flap from the lateral canthus was elevated and transposed to the lower eyelid to suspend the lower eyelid and repair the skin defect. Results: Satisfactory eyelid function and cosmetic appearance were obtained and no recurrence was found in 2-years follow-up. The method proved that the donor scar was well hidden in the supratarsal crease. Mild flap color change occurred in the early stages but disappeared gradually within 2 months after. Conclusions: The use of this flap not only gives similar tissue reconstruction, additional support, well-hidden scar, and no loss of function, but also fast flap rising with the reliable donor. With a thorough knowledge of anatomy, the authors believe that their technique described below will expand anatomical understanding and powerful reasons for using laterally based orbicularis oculi myocutaneous flap for not only reconstructive but also aesthetic surgeons.

Facial Defects With Infraorbital and Zygomatic Area Reconstruction Using an Expanded Flap Based on the Orbicularis Oculi Muscle: A Long-Term Follow-up

“…Second, the superior border of the pedicle must be kept more than 3 mm away from the margin of the lower eyelid 5. The pretarsal portion of the lower lid is responsible for both the upward movement and the closing of the lower lid and has a bend-like effect that attaches the superficial tissue to the tarsus 14. This method is not suitable for tissue defects that are in other areas in the face except the infraorbital and zygomatic areas, and this is the main limitation of our method.…”

Periocular Malignancies and Postoperative Eyelid Reconstruction

“…It is worthwhile to note that defects affecting one-third to half of the lower eyelid can be repaired with a unipedicled flap. In contrast, faults affecting the entire lower eyelid can be reconstructed with a bipedicled flap 88,90 …”

“…In contrast, faults affecting the entire lower eyelid can be reconstructed with a bipedicled flap. 88,90 Fricke (Temporal Forehead) Flap Jochim Fricke described the temporal forehead flap for the first time in 1829. 91 It is a laterally based, unipedicled transposition flap raised above the eyebrow, which can be used to reconstruct large lower and upper eyelid and lateral canthal defects.…”