title: One-Stage Alternatives to the Hughes Procedure for Reconstruction of Large Lower Eyelid Defects: Surgical Techniques and Outcomes.
abstract: OBJECTIVE
  To present the results of 1-stage surgical advancement flaps for the repair of large full thickness lower eyelid defects. These avoid the disadvantages of the 2-stage Hughes procedure and provide favorable functional and aesthetic outcomes.
  
  
  METHODS
  A retrospective case series of 36 lower eyelid repairs performed on 31 patients by a single surgeon in Sydney, Australia is presented. The selection criterion was a horizontal defect size 10 mm or greater that could have "classically" been repaired with a 2-stage Hughes procedure. Three different 1-stage surgical repair techniques were utilized, all incorporating local advancement-type flaps: 1) a lateral-based full thickness advancement flap; 2) a vertical tarsal plate advancement flap combined with a full thickness skin graft; and 3) a vertical skin advancement flap combined with a mucosal graft. The postoperative outcomes evaluated included flap viability, lower eyelid margin position and contour, characteristics of the new eyelid margin and patient satisfaction.
  
  
  RESULTS
  Thirty-six lower eyelid repairs were performed in 31 patients. There were no cases of flap ischemia, necrosis, or failure. There was 1 case (3%) of postoperative eyelid retraction, 1 case (3%) of eyelid entropion requiring surgical repair, 1 case (3%) of pyogenic granuloma, 2 cases (6%) of eyelid margin cyst, and 7 cases (19%) of eyelid distichiasis. In 34 cases (94%), the patient was satisfied with the aesthetic result.
  
  
  CONCLUSIONS
  The techniques described provide successful alternatives to the Hughes procedure. They are 1-stage and do not render the patient temporarily monocular, or alter the upper eyelid anatomy or function. All maintained favorable long-term functional and aesthetic outcomes for the reconstructed lower eyelid.
authors.affiliation: *University Hospital of Wales, Cardiff, United Kingdom; †Manchester Royal Eye Hospital, Manchester, United Kingdom; ‡Drummoyne Day Surgery Centre, Sydney, Australia; and §Sydney Eye Hospital, Sydney, Australia.
authors.forename: Brent
authors.initials: B
authors.lastname: Skippen
authors.forename: Alex
authors.initials: A
authors.lastname: Hamilton
authors.forename: Sam
authors.initials: S
authors.lastname: Evans
authors.forename: Ross
authors.initials: R
authors.lastname: Benger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005141:Eyelid Diseases / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures; D017060:Patient Satisfaction; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D013524:Surgical Flaps