title: Key Issues When Reconstructing Extensive Upper Eyelid Defects With Description of a Dynamic, Frontalis Turnover Flap.
abstract: Reconstruction of full thickness, total upper eyelid defects represents a significant challenge in terms of recreating an upper eyelid which has acceptable cosmesis and a degree of dynamic function. Options include bridging, eyelid-sharing techniques (e.g., Cutler-Beard), or nonbridging techniques such as an anterior lamella-based flap combined with a posterior lamella free graft or a "sandwich flap." The success of these techniques depends on the size of the defect, postoperative cosmesis and whether or not the upper eyelid still has a degree of dynamic function to avoid ptosis and exposure keratopathy. The authors present an innervated frontalis turnover flap supporting anterior and posterior lamella grafts as a reconstructive solution for an extensive upper eyelid defect. This technique is cosmetically acceptable, preserves local tissues, and maintains a degree of dynamic function, which keeps the patient's eye comfortable and does not adversely affect visual acuity.
authors.affiliation: *Oxford Eye Hospital, and †Department of Plastic and Reconstructive Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Stewart
authors.forename: Lee Teak
authors.initials: LT
authors.lastname: Tan
authors.forename: David
authors.initials: D
authors.lastname: Johnson
authors.forename: Jonathan H
authors.initials: JH
authors.lastname: Norris
mesh_terms: D000368:Aged; D019882:Blepharoplasty / Q000379:methods*; D005142:Eyelid Neoplasms / Q000601:surgery*; D005143:Eyelids / Q000601:surgery*; D006801:Humans; D008297:Male; D016038:Skin Transplantation / Q000379:methods*; D013524:Surgical Flaps