title: A technique for the reconstruction of lower eyelid marginal defects.
abstract: OBJECTIVE
  To report on a new one-step technique for the reconstruction of lower eyelid marginal defects.
  
  
  METHODS
  Retrospective case series of 5 patients with lower eyelid basal cell carcinomas abutting the eyelid margin. In all patients, the tumour was radically excised with a 3-mm clear cutaneous margin and a 2-mm tarsoconjunctival margin under frozen section control. Defect size ranged from 12 to 22 mm horizontally and from 8 to 9 mm vertically. For eyelid reconstruction, the 2-mm residual lower lid tarsus was advanced superiorly on a conjunctival pedicle and sutured into the posterior lamella defect. The anterior lamella was reconstructed with orbicularis muscle advancement and a free skin graft from the ipsilateral upper eyelid. The outcome following surgery was assessed using a subjective scoring system with 4 subsequent grades (poor, adequate, good, excellent).
  
  
  RESULTS
  At 1 week postoperatively, adequate viability of the grafts was noted in all patients. One patient developed transient punctate epithelial keratopathy. After a mean follow-up of 10 months (range 1 to 21 months) the outcome was "poor" in 0 patients, "adequate" in 0 cases, "good" in 1 case and "excellent" in 4 cases.
  
  
  CONCLUSIONS
  Reconstruction of small to large lower lid marginal defects with local tarsoconjunctival flap advancement combined with orbicularis muscle advancement and free skin graft is associated with a good functional and cosmetic outcome and limited donor-site morbidity.
authors.affiliation: Department of Oculoplastic and Orbital Surgery, The Rotterdam Eye Hospital, Schiedamsevest 180, 3011 BH Rotterdam, The Netherlands.
authors.forename: Ingemarie
authors.initials: I
authors.lastname: Moesen
authors.forename: Dion
authors.initials: D
authors.lastname: Paridaens
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002280:Basal Cell Carcinoma / Q000601:surgery*; D003228:Conjunctiva / Q000601:surgery; D004954:Esthetics; D005142:Eyelid Neoplasms / Q000601:surgery*; D005143:Eyelids / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000601:surgery; D013508:Ophthalmologic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D016038:Skin Transplantation; D013524:Surgical Flaps; D016896:Treatment Outcome