Repair of lower eyelid free margin defects by means of myocutaneous island flap from the upper eyelid

Cancer surgery is the most common cause of eyelid skin loss, followed by traumatic avulsions, burn injuries or sequelae of cosmetic surgery. Skin defects, if not adequately treated, lead to mild to severe lid retraction or ectropion. There are many surgical options and the choice depends on the amount of eyelid skin missing. The upper eyelid, especially in senior patients, is a good donor area for defects of the lower eyelid. The skin can be harvested and transposed as a free graft as well as a flap. In a previous paper we described a myocutaneous flap harvested from the upper eyelid for the repair of lower eyelid defects. The same flap harvested from the upper eyelid can be used to repair defects widely involving the margin of the lower eyelid. The anatomical and clinical bases of this flap are discussed and its main application in these cases is reported. The technique was adequately modified in order to reach repair not only of the skin, but of the full thickness defect (skin, conjunctiva and tarsal support) and restore the lid margin continuity. In fact, in case of involvement of the eyelid margin, a full thickness resection has to be performed leaving a composite defect; skin and pretarsal orbicularis muscle, tarsus and conjunctiva are missing and a three-layer repair is necessary. While the conjunctival surface can be repaired by folding the flap skin island, to restore tarsal continuity and give support to the lid margin, a small graft of cartilage is required: this is usually harvested from the upper lateral cartilage of the nose or from the auricolar choncha. The technique was applied on 12 patients. AU the patients operated on achieved complete repair of the lid defect. The long-term outcome of this technique was considered more than satisfactory both from a functional and aesthetic point of view.