title: A New Approach to Upper Eyelid Reconstruction.
abstract: BACKGROUND
  Reconstruction of large defects of the upper eyelid is challenging because of its complex anatomy and specialized function. The aim of this work is to develop a single-stage reconstruction procedure based on a new approach. The technique consists of the advancement of an orbicularis oculi myocutaneous flap designed within the blepharoplasty skin excision pattern.
  
  
  METHODS
  After the tumor's excision is completed with clear margins, the borders of the flap are incised down to the submuscular plane inside the classical pattern of upper eyelid blepharoplasty. Two myocutaneous triangles are excised on both sides of the flap to allow its advancement to cover the defect. When it is necessary to repair the posterior lamella, we harvest a mucochondral graft.
  
  
  RESULTS
  From 2012 to 2015, we performed upper eyelid reconstruction with this technique on six patients. The flap survived in all the patients, without total or partial necrosis. No patient required surgical revision. The results were aesthetically satisfying, and no tumor recurrence was noted.
  
  
  CONCLUSIONS
  Our new approach to upper eyelid reconstruction maximizes the cosmetic outcome respecting the principles of radicality. This flap is better suited for lesions involving the median or paramedian eyelid border from the marginal zone up to the palpebral crease. The approach we propose is safe and versatile, and it ensures either a functional or a good aesthetic reconstruction.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
authors.affiliation: Department of Surgical, Microsurgical and Medical Sciences, Plastic Surgery Unit, University of Sassari, Viale San Pietro 43, 07100, Sassari, Italy. abulla80@gmail.com.|Department of Biomedical Sciences - Human Anatomy, University of Sassari, Viale San Pietro 43, 07100, Sassari, Italy. abulla80@gmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Bulla
authors.affiliation: Department of Surgical, Microsurgical and Medical Sciences, Plastic Surgery Unit, University of Sassari, Viale San Pietro 43, 07100, Sassari, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Vielà
authors.affiliation: Department of Surgical, Microsurgical and Medical Sciences, Plastic Surgery Unit, University of Sassari, Viale San Pietro 43, 07100, Sassari, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Fiorot
authors.affiliation: Department of Surgical, Microsurgical and Medical Sciences, Plastic Surgery Unit, University of Sassari, Viale San Pietro 43, 07100, Sassari, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Bolletta
authors.affiliation: Department of Surgical, Microsurgical and Medical Sciences, Plastic Surgery Unit, University of Sassari, Viale San Pietro 43, 07100, Sassari, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Pancrazi
authors.affiliation: Department of Surgical, Microsurgical and Medical Sciences, Plastic Surgery Unit, University of Sassari, Viale San Pietro 43, 07100, Sassari, Italy.
authors.forename: G V
authors.initials: GV
authors.lastname: Campus
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019882:Blepharoplasty / Q000379:methods*; D005142:Eyelid Neoplasms / Q000601:surgery*; D005143:Eyelids / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D064827:Myocutaneous Flap; D055171:Nasal Cartilages / Q000637:transplantation; D009297:Nasal Mucosa / Q000637:transplantation; D009300:Nasal Septum / Q000637:transplantation; D019651:Plastic Surgery Procedures / Q000379:methods*
keywords: Blepharoplasty; Eyelid reconstruction; Skin cancer