Abstract
In periocular reconstruction after cancer resection, three aspects should be considered : 1) the oncological aspect, 2) the functional aspect, 3) the aesthetic aspect. A one-stage operation is oncologically better, because it allows early adjuvant therapy. The flap is desirably harvested from a nearby area to match the color and texture. However, in the case of a highly malignant tumor, the flaps containing lymphatic vessels between the tumor and the lymph nodes should be avoided. We think transferring functional orbicularis oris muscle to the upper lid margin enables the eye to close more securely.
We reconstructed the periocular region after resection of highly malignant tumors with a one-stage operation, namely, median forehead flap, orbicularis oris bi-pedicle flap, or free radial forearm flap, etc. In case of the free flap, we think replacing the free flap skin by skin graft harvested from a nearby area such as the subclavicular area allows the color and texture to match better. We used standard methods after resection of low and moderate malignant tumors, namely, switch flap from the lower eyelid, lateral orbital flap, etc. These flaps are aesthetically better than median forehead flaps. There was no local recurrence in 27 cases after a mean follow-up period of 5 years.[Skin Cancer (Japan) 2009 ; 24 : 409-415]
