title: Single-stage frontalis muscle flap for full-thickness reconstruction of the upper eyelid.
abstract: BACKGROUND
  Full-thickness upper eyelid defects present a reconstructive challenge. Defects greater than 50% of the upper eyelid have traditionally been reconstructed with bulky full-thickness forehead flaps, Cutler-Beard flaps, Mustarde eyelid switches, and cheek rotation advancements, all mandating a second-stage surgical procedure. We propose a novel technique for full-thickness upper eyelid reconstruction based on a frontalis muscle flap elevated from the resection defect, thus resulting in no additional forehead scar.
  
  
  METHODS
  Our patient is a 48-year-old woman with an enlarging right upper eyelid sebaceous cell carcinoma. A subsequent single-stage resection resulted in a medial full-thickness defect of 75% of the upper eyelid. The lateral and medial canthi were preserved. A palatal mucoperiosteal graft was harvested for the reconstruction of the posterior lamella. Dissection was carried through the excision defect in a preseptal plane over the supraorbital rim and subcutaneously over the frontalis muscle. A caudally pedicled frontalis muscle flap was elevated and inset to the defect edges with mild tension. Reconstruction of the skin defect of the upper eyelid was completed with a full-thickness preauricular skin graft.
  
  
  RESULTS
  The patient had no complications and demonstrated good function and aesthetic result at 15 weeks and at 9 months postoperatively.
  
  
  CONCLUSIONS
  Frontalis muscle flap-based reconstruction offers a viable option for upper eyelid defects that are full thickness and encompass more than 50% of the eyelid. We obtained a functionally and aesthetically pleasing outcome with this single-stage procedure using a preexisting incision with minimal donor-site morbidity.
authors.affiliation: Loma Linda University, Loma Linda, California, USA.
authors.forename: Raymond D
authors.initials: RD
authors.lastname: Jean
authors.forename: Wendy W
authors.initials: WW
authors.lastname: Wong
authors.forename: Mark C
authors.initials: MC
authors.lastname: Martin
mesh_terms: D005142:Eyelid Neoplasms / Q000601:surgery*; D005152:Facial Muscles / Q000637:transplantation*; D005260:Female; D006801:Humans; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012626:Sebaceous Gland Neoplasms / Q000601:surgery*; D013524:Surgical Flaps