title: Orbicularis muscle advancement flap combined with free posterior and anterior lamellar grafts: a 1-stage sandwich technique for eyelid reconstruction.
abstract: OBJECTIVE
  To report on a new 1-stage technique for eyelid reconstruction.
  
  
  METHODS
  Retrospective interventional case series.
  
  
  METHODS
  Thirteen patients with shallow full-thickness lower eyelid defects (n = 12) or a full-thickness upper eyelid defect (n = 1) after tumor excision. Defect size ranged from 5 to 10 mm vertically and from 10 to 22 mm horizontally.
  
  
  METHODS
  For eyelid reconstruction, the orbicularis muscle adjacent to the defect was mobilized, incised vertically, and advanced. The inner surface was covered with a free tarsoconjunctival graft from the (ipsilateral or contralateral) upper lid, and the outer surface was covered with a free skin graft from the (ipsilateral or contralateral) upper eyelid.
  
  
  METHODS
  The outcome at 12 months after surgery was assessed using a subjective scoring system with 4 subsequent grades (poor, adequate, good, excellent).
  
  
  RESULTS
  After 5 days of patching, adequate viability of the grafts was noted in 11 of 13 patients. In 2 patients, partial necrosis of the skin graft developed, probably the result of hematoma. Complications included ectropion or lid retraction (3/13), granuloma (2/13), and notching (1/13). Two patients underwent additional block excision. The long-term outcome at 12 months after surgery was poor in 0 cases, adequate in 2 cases, good in 7 cases, and excellent in 4 cases.
  
  
  CONCLUSIONS
  The sandwich technique for eyelid reconstruction comprises the use of an orbicularis oculi muscle advancement flap, which is covered with a free graft on both sides. It allows for 1-stage reconstruction of relatively shallow lower eyelid defects with a horizontal size of up to 70% of the total eyelid width and may be a 1-stage alternative to the modified Hughes flap in selected cases.
authors.affiliation: Department of Oculoplastic and Orbital Surgery, Rotterdam Eye Hospital, Rotterdam, Netherlands. paridaens@icapi.nl
authors.forename: Dion
authors.initials: D
authors.lastname: Paridaens
authors.forename: Willem A
authors.initials: WA
authors.lastname: van den Bosch
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019882:Blepharoplasty / Q000379:methods*; D003228:Conjunctiva / Q000637:transplantation; D005142:Eyelid Neoplasms / Q000601:surgery*; D005143:Eyelids / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000601:surgery*; D010865:Pilot Projects; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D016038:Skin Transplantation; D013524:Surgical Flaps