title: Total lower lid reconstruction: clinical outcomes of utilizing three-layer flap and graft in one session.
abstract: OBJECTIVE
  To report the clinical outcomes of utilizing a three-layer flap and graft in reconstruction of the lower lid in one session.
  
  
  METHODS
  Seventeen patients with total or near total lower eyelid defect were included. The defects were reconstructed in three layers. Posterior lamella was reconstructed by using tarsoconjunctival free graft from the ipsilateral upper lid and periosteal flap from lateral orbital rim. Mobilization of residual orbicularis muscle provided a rich blood supply; and the anterior lamella was reconstructed by skin flap prepared from upper lid blepharoplasty as a one-pedicular or bipedicular bucket handle flap.
  
  
  RESULTS
  The cause of lower eyelid defect was basal cell carcinoma in 15 patients and trauma in two of them. No intraoperative and postoperative complication occurred. Patients were followed from 10 to 15mo postoperatively. Cosmetic results were favorable in all patients and we had acceptable functional results. Thickness of the reconstructed tissue was a concern in early postoperative period.
  
  
  CONCLUSIONS
  Three-layer lower lid reconstruction in one session is an effective technique for total lower lid reconstruction with minimal complications and acceptable functional and aesthetic outcomes and can be considered as a safe alternative for the preexisting techniques.
authors: Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran 1336616351, Iran.
authors: Mohammad Taher
authors: MT
authors: Rajabi
authors: Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran 1336616351, Iran.
authors: Fatemeh
authors: F
authors: Bazvand
authors: Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran 1336616351, Iran.
authors: Seyedeh Simindokht
authors: SS
authors: Hosseini
authors: Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran 1336616351, Iran.
authors: Ali
authors: A
authors: Makateb
authors: Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran 1336616351, Iran.
authors: Mohammad Bagher
authors: MB
authors: Rajabi
authors: Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran 1336616351, Iran.
authors: Syed Ziaeddin
authors: SZ
authors: Tabatabaie
authors: Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran 1336616351, Iran.
authors: Yalda
authors: Y
authors: Abrishami
keywords: anterior lamella; blepharoplasty skin flap; lower lid reconstruction; orbicularis muscular flap; posterior lamella; tarsoconjuctival graft