title: Extensive full-thickness eyelid reconstruction with rotation flaps through "subcutaneous tunnel" and palatal mucosal grafts.
abstract: OBJECTIVE
  To reconstruct the extensive full-thickness defects of eyelids is a challenge for the plastic surgeon because of their complex anatomy and special functions. This article presents and discusses an improved surgical technique in which the orbicularis oculi myocutaneous flap is rotated through a "subcutaneous tunnel" in conjunction with a palatal mucosal graft employed for lining.
  
  
  METHODS
  Data from 22 eyes with extensive full-thickness eyelid defects from various causes between 2009 and 2013 were analyzed in this study. After the different layers of eyelid were separated completely, a temporally based orbicularis oculi myocutaneous flap was designed following fishtail lines and was mobilized, leaving the base of the pedicle intact with a submuscular tissue attachment. The flap was then rotated through a "subcutaneous tunnel" to the defect, and the donor site was closed primarily. Posterior lamellar reconstruction was performed with a mucosal graft harvested from the hard palate.
  
  
  RESULTS
  All the flaps were survived without any healing problems. There was no corneal irritation, flap contraction, or significant donor-site morbidity in the follow-up period. The incision scars were almost invisible. The defects were repaired completely, and the evaluations showed satisfactory function and appearance.
  
  
  CONCLUSIONS
  This technique is an improved single-stage operation and can be applied to repair large, full-thickness eyelid defects from various causes. With our method, the functional and aesthetic results can be obtained in either the upper or lower eyelids.
authors: Department of Ocular Plastic Surgery, the Second Hospital of Jilin University, Changchun 130033, Jilin Province, China.
authors: Jian-Xia
authors: JX
authors: Cheng
authors: Department of Ocular Plastic Surgery, the Second Hospital of Jilin University, Changchun 130033, Jilin Province, China.
authors: Lan
authors: L
authors: Zuo
authors: Department of Ocular Plastic Surgery, the Second Hospital of Jilin University, Changchun 130033, Jilin Province, China.
authors: Xin-Yu
authors: XY
authors: Huang
authors: Department of Ocular Plastic Surgery, the Second Hospital of Jilin University, Changchun 130033, Jilin Province, China.
authors: Ji-Zhe
authors: JZ
authors: Cui
authors: Department of Ocular Plastic Surgery, the Second Hospital of Jilin University, Changchun 130033, Jilin Province, China.
authors: Shuai
authors: S
authors: Wu
authors: Department of Ocular Plastic Surgery, the Second Hospital of Jilin University, Changchun 130033, Jilin Province, China.
authors: Yuan-Yuan
authors: YY
authors: Du
keywords: full-thickness eyelid defects; hard palate mucosa; orbicularis oculi myocutaneous flap; subcutaneous tunnel