Medial and Lateral Canthal Reconstruction with an Orbicularis Oculi Myocutaneous Island Flap

Abstract

BackgroundThe eyelid and canthal areas are common locations for cutaneous tumors. The medial canthus includes, among many other apparatuses, the canthal tendon and lacrimal canaliculi, and its characteristic thin and supple skin is hard to mimic and restore using tissue from other regions. Accordingly, reconstruction of the canthal area can prove challenging for surgeons. Although various methods, such as skin grafts and local flaps from adjacent regions, have been utilized for reconstructive purposes, they present known disadvantages. However, we were able to successfully reconstruct both lateral and medial canthal area defects by using orbicularis oculi myocutaneous island flaps.MethodsOur study included seven patients who underwent medial or lateral canthal region reconstruction, using orbicularis oculi myocutaneous island flaps, between 2011 and 2014, following either cutaneous tumor excision or traumatic avulsion injury.ResultsFive patients had basal cell carcinoma, one had squamous cell carcinoma of the eyelid, and one had sustained a traumatic avulsion injury of the eyelid and canthal area. Entire flap loss was not observed in any patient, but one-a heavy smoker-showed partial flap loss, which healed with secondary intention and yielded acceptable results. Donor site morbidity was not observed, and all patients were satisfied with their surgical outcomes.ConclusionsThe canthal regions can be successfully reconstructed with orbicularis oculi myocutaneous island flaps. These flaps offer several key advantages, including similarity in texture, color, and thickness to the recipient site and a negligible incidence of donor site morbidity.

Reconstruction of Combined Full-Thickness Defect of the Lateral Canthus and Lateral Upper and Lower Third Eyelids With an Extended Modification of the Fricke Flap, Periosteal Flap, and Conjunctival Flap

“…For combination defects of this nature, cheek advancement flaps, combinations of flaps and skin grafts, and hard palate and cartilage grafts have all been described as options for reconstruction. [8][9][10][11][12][13] We believe our modification of the Fricke flap, when possible, can offer a superior cosmetic result when compared with these other methods.…”

Orbicularis Bi-Pedicle flap: A single-staged surgical technique for the reconstruction of large and shallow, upper or lower eyelid defect

“…We feel that an Orbicularis myocutaneous flap is sufficient only to replace a large anterior lamellar defect. Han et al 17 used the myocutaneous orbicular island flap to reconstruct superficial, medial and lateral canthal defects in 7 cases with good results. This flap has also been used in upper lid blepharoplasty.…”

Rhomboid flap: An option to medial canthal reconstruction

“…The surgical dilemma comes from the quality of the skin removed and the thickness of the tissue available for replacement. Several techniques are used to repair medial canthal defects: Simple laissez faire [11,12], free full thickness, skin grafts [1,11], rotational flap [4], glabellar flap [3], glabellar bilobed flap [11,12], bipalpebral sliding flaps [13], upper eyelid myocutaneous flap [14,15], islands flaps, tunnelled forehead flaps [16] V-Y advancement flaps [4], and rhomboidal flaps [1,9], The rhomboid flap is a flap of skin and subcutaneous tissue that is rotated around a pivot point into an adjacent defect [1]. It has special application for eyelid, floor of nose, alar rim and chin defects.…”