title: Secondary tarsoconjunctival graft: a modification to the Cutler-Beard procedure.
abstract: OBJECTIVE
  The Cutler-Beard procedure is a commonly used technique to reconstruct large upper eyelid defects. Eyelid retraction and entropion are common complications. To prevent these problems, the authors modified the traditional Cutler-Beard procedure with secondary placement of an autologous tarsoconjunctival graft.
  
  
  METHODS
  This is a retrospective review of 2 patients with large upper eyelid defects necessitating upper eyelid reconstruction. The initial stage is unaltered. At the time of flap division, a tarsoconjunctival graft from the contralateral upper eyelid is sutured to the posterior surface of the newly constructed upper eyelid. Two patients underwent this procedure, and follow up was 4 and 23 months, respectively. Patients developed no postoperative complications, including entropion or retraction.
  
  
  CONCLUSIONS
  This modification to the Cutler-Beard operation is a technically simple procedure that can restore a more anatomically correct eyelid and can prevent subsequent entropion or retraction. This technique is unique, offering 3 major advances: first, placing the graft at the second surgical stage; second, replacing the tarsus and conjunctiva with like tissue; and third, preserving a lip of conjunctiva to cover the edge of the newly reconstructed upper eyelid.
authors: Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA.
authors: Michael K
authors: MK
authors: Yoon
authors: Timothy J
authors: TJ
authors: McCulley
mesh_terms: D000328:Adult; D002280:Basal Cell Carcinoma / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D003228:Conjunctiva / Q000637:transplantation*; D005141:Eyelid Diseases / Q000601:surgery*; D005142:Eyelid Neoplasms / Q000601:surgery; D005143:Eyelids / Q000293:injuries / Q000637:transplantation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000601:surgery