Reconstruction of a Large Surgical Defect on the Lower Eyelid and Infraorbital Cheek

Abstract

An 83-year-old white woman was referred for Mohs micrographic surgery of a lentigo maligna on the left malar cheek. The tumor was completely removed in four stages, leaving an irregularly shaped defect that measured 3.8 x 4.7 cm and that involved the left lower lateral eyelid and infraorbital cheek (Figure 1). How would you reconstruct this defect?

Total reconstruction of lower eyelid in a post-traumatic patient using modified fricke′s cheek flap

“…In his case series on reconstruction of lower eyelids, Barba-Gómez et al .,[3] have considered many such techniques like the method described by Mustarde,[2] the Hughes[4] transposition flap with its modifications,[5] the eyelid[6] cutaneous rim graft, the hard palate graft covered by an orbicularis oculi myocutaneous advancement flap,[7] the Tripier[8] flap, and more complex approaches such as the pre-expansion mucosa-lined tongue flap,[9] the use of acellular human dermis,[1011] the cheek flap supported by fascia lata,[12] the island tarsoconjuctival mucochondrocutaneous flap,[1314] and the use of an expanded forehead Fricke flap. [151617] All of these techniques are useful when reconstruction of the lower eyelid is required; however, some of these procedures are complex and expensive.…”

Nasal Tip Wound Repair Using a Rhombic Transposition Flap with a Double Z-Plasty at Its Base

“…The first Z‐plasty triangle is created with a 90° to 105° angle to the rhombic flap and with one 60° degree angle in the Z‐plasty tip, while the second Z‐plasty triangle is created at a 90° angle to the first Z‐plasty and a 60° angle in the second Z‐plasty tip (Figure 2). Although the angle between the first and second Z‐plasty was originally described as 60°, we have observed that a 90° angle works better 7 . The bilobed transposition flap uses a similar design concept.…”

“…Although the angle between the first and second Z-plasty was originally described as 601, we have observed that a 901 angle works better. 7 The bilobed transposition flap uses a similar design concept. The bilobed flap, however, uses two large rounded donor flaps, rather than one rhombic flap and two smaller Z-plasty flaps.…”

Reconstruction of Defects of the Infraorbital Malar Cheek

“…Several authors have proposed the combination of several small flaps for large defects 2,3 . This approach may eliminate the need for advanced surgical skills.…”

“…The combination of a side‐to‐side tissue advancement with a Burow's graft has been successfully employed in upper malar defects 4 . Another option for defects in this area is the combination of a rhombic transposition flap and a subsequent single‐lobe transposition flap from the upper eyelid (Tripier flap) to close the upper portion of the defect 3 …”