Partial and Total Lower Lid Reconstruction: Our Experience with 41 Cases

Abstract

Purpose: To report our experience on lid reconstruction in patients with epitheliomas. Methods: A total of 41 consecutive patients affected by basal cell (n = 32) or squamous cell carcinoma (n = 9) underwent partial (n = 35) or total (n = 6) surgical demolition of the lower lid. Surgical defects <25% (n = 10) received direct closure. If the defect involved 30–60% of the eyelid (n = 21), a Tenzel semicircular flap or lateral advancement flap with a free mucosal graft was used. If the entire lid or a major part of the outer lamella had to be reconstructed (n = 10), a cheek advancement flap was used, with a free mucosal graft if the posterior lamella was involved. The success rates and the cosmetic and functional results were evaluated. Results: All 21 flaps used for partial reconstruction remained viable, whereas 1 of the 10 cheek flaps developed partial distal necrosis. Of the 27 mucosal grafts, 2 had to be removed for total necrosis, and 2 developed partial necrosis. In all cases, normal lid function and acceptable cosmetic results were obtained. Complications occurring in 4 cases (1 ectropion and 3 epiphora) were successfully managed with appropriate surgical procedures. Conclusions: Local flaps are the gold standard for lower lid reconstruction as they are highly reliable and guarantee optimal results. The technical details described in this study can help in achieving such results.

Eyelid Reconstruction Following Excision of Cutaneous Malignancy

“…20 Flaps are usually preferred over grafts because homogeneity of skin color and texture more likely leads to better unification with surrounding tissue. 21 Various types of flaps can be fashioned in the periocular tissues. Reconstructive options regarding flaps range from local flaps to distant free flaps.…”

Oncologic Surgery of the Eyelid and Orbital Region

“…Applying the basic principles of eyelid surgery, defects of less than a quarter of the total area of the lower eyelid can be closed by direct suture 9,12 (Fig. 4).…”

“…9,12 In a lateral canthotomy, a horizontal incision is made from the lateral canthus to the lateral orbital margin, and the orbicularis oculi muscle is then sectioned to reveal the periostium. 5 Cantholysis consists of sectioning the canthal tendon, which can be identified by pulling the lateral part of the eyelid upwards and outwards, with the tendon incision being made in the area of resistance to this movement; this will release the lower eyelid from the orbital ring.…”

Cirugía oncológica de párpado y la región orbitaria

“…Como principios básicos de la cirugía de párpado, ante defectos menores de ¼ del total del párpado inferior se puede realizar un cierre directo 9,12 (fig. 4).…”