COSMETIC EYE LID RECONSTRUCTION WITH FLAPS

Abstract

Local flaps for reconstruction of the outer lamella of eye lids have many advantages, including an excellent skin color and texture match. An advancement flap based on the orbicularis oculi muscle is available. A lower lid switch flap is functionally and esthetically useful for defects of the upper eye lid. For large defects of the upper eye lid, thin flaps, an auricular island flap and a radial forearm flap are available for reconstruction of the movable upper eye lid. When a total upper eye lid reconstruction is performed using a radial forearm flap with a hard palate mucosal graft, despite lack of levator function, our patients can raise their eye lid by using only the superior rectus muscle without frontalis suspension. The reconstructed upper eye lid results in an excellent color and texture match. Another free flap is used for the loss of total eye lids and orbital content. An anterolateral thigh flap is inferior in color and texture match to the ratissimus dorsi musclocutaneous flap and rectus abdominis musculocutaneous flap. A median forehead flap combined with tissue expander offers excellent color and texture match, but staged operation is a disadvantage. For defects of the lower eye lid, a nasolabial flap, a transverse musculocutaneous flap from the upper eye lid, and a cheek rotation flap can be used. A conchal cartilage graft without skin is used as a posterior lining for lower eye lid reconstruction. The raw surface of the graft is smooth enough to cause no corneal irritation and is epithelialized from the surrounding mucosa. If the fornix is not reserved, the lining of the lower eye lid should be reconstructed with nasal chondromucosa.