Upper eyelid myocutaneous flap for the repair of lower eyelid skin defects

Lesions leading to a skin defect of the lower eyelid are quite frequent. The most frequent cause of eyelid defects is skin cancer resection. Other causes are traumatic avulsion, burn injuries or sequelae of erred cosmetic procedures. 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. A myocutaneous flap harvested from the upper eyelid is frequently used for the repair of lower eyelid defects. The anatomical and clinical bases of this flap are reported, its main applications are discussed and its reliability is confirmed. The flap is thin and pliable, its rotation is easy and it can easily reach and seal defects of the skin and muscle layers of the lower eyelid by a single-step procedure. The first step is a wide, oncologically radical resection of the cancer; after that, the flap is harvested from the upper lid using a blepharoplasty-like incision. The orbicularis muscle flap with the skin island is then elevated; its pedicle is on the lateral side. After that the flap is passed through a tunnel undermined at the lateral canthal area, thus being able to reach the lower lid defect. The described technique was applied on 23 patients after resection of skin cancers of the lower eyelid. Complete repair of the skin defect with excellent wound healing was obtained in all cases. All the patients had good results both from the functional and from the aesthetic point of view.