Reconstruction of the lower eye lid with a rotation-advancement tarsoconjunctival cheek flap.
Repair of full-thickness defects of the lower eyelids poses a challenge because a graft in combination with a flap is typically used to replace either the posterior or the anterior lamella. This often results in aesthetically and functional unsatisfactory outcomes. A rotation-advancement tarsoconjunctival cheek flap, which reconstructs both posterior and anterior lamellae with vascularized tissue similar to the native eyelid, is described. Nine patients underwent reconstruction with a rotation-advancement tarsoconjunctival cheek flap. Indications, complications, and outcomes were evaluated. The follow-up time ranged from 6 to 60 months, with a mean of 23 months. The main indication for use of this flap is full-thickness defect of the lower eyelid between 25% and 75%, typically after tumor ablation. All patients had a functional and aesthetically satisfactory outcome. One patient underwent a revision canthoplasty. The rotation-advancement tarsoconjunctival cheek flap adheres to basic plastic surgery principles resulting in a satisfactory outcome: vascularized tissue is used to reconstruct the defect, the flap composition is similar to the native eyelid, that is, replace like with like, and the flap makes use of tissue that is in excess and therefore limits donor morbidity.
Division of Plastic & Reconstructive Surgery, Faculty of Health Sciences, University of Stellenbosch, Western Cape, South Africa. wlfwessels@gmail.com
William Louis Fick
WL
Wessels
F R
FR
Graewe
Petrus V
PV
van Deventer
D000368:Aged; D000369:Aged, 80 and over; D002280:Basal Cell Carcinoma / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D002610:Cheek / Q000601:surgery; D003228:Conjunctiva / Q000637:transplantation*; D004954:Esthetics; D005142:Eyelid Neoplasms / Q000601:surgery; D005143:Eyelids / Q000502:physiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D016038:Skin Transplantation / Q000379:methods*; D013524:Surgical Flaps; D020858:Tissue and Organ Harvesting / Q000379:methods; D016896:Treatment Outcome