A technique for reconstruction of upper lid marginal defects

Abstract

Background/aims: Reconstruction of large full thickness upper lid defects that cannot be closed directly often rely on utilising the lower lid. An example is the Cutler Beard procedure. A one stage technique for repair of large horizontal upper lid defects utilising local posterior and anterior lamella advancement flaps is described and the results reported.

Method: Eight cases with upper lid defects repaired utilising this technique were reviewed retrospectively. The procedures were carried out by one surgeon. The upper lid lesions were removed under frozen section control. The mean follow up time was 35 months.

Results: All patients had a good cosmetic result. One patient had a recurrence of the upper lid lesion. Two patients complained of corneal irritation from lanugo hairs. The technique was modified to prevent this complication.

Conclusions: Large upper lid marginal defects can be readily repaired using the technique described with local advancement flaps with no significant complications.

Figure 1

Upper lid basal cell carcinoma marked with 3 mm margins.

Figure 2

Upper lid defect once lesion excised with clear margins.

Figure 3

(A) Upper lid anterior lamella advancement flap marked including redundant Burrow’s triangles. (B) Advancement of tarsoconjunctival flap. (C) Tarsus sutured in advanced position forming new posterior lamella lid margin.

Figure 3

(A) Upper lid anterior lamella advancement flap marked including redundant Burrow’s triangles. (B) Advancement of tarsoconjunctival flap. (C) Tarsus sutured in advanced position forming new posterior lamella lid margin.

Figure 3

(A) Upper lid anterior lamella advancement flap marked including redundant Burrow’s triangles. (B) Advancement of tarsoconjunctival flap. (C) Tarsus sutured in advanced position forming new posterior lamella lid margin.

Figure 4

(A) Skin and orbicularis are undermined to form anterior lamella advancement flap. (B) Redundant skin is excised. (C) Skin edges are sutured.

Figure 4

(A) Skin and orbicularis are undermined to form anterior lamella advancement flap. (B) Redundant skin is excised. (C) Skin edges are sutured.

Figure 4

(A) Skin and orbicularis are undermined to form anterior lamella advancement flap. (B) Redundant skin is excised. (C) Skin edges are sutured.

Figure 5

Sutures passed through levator and skin to form new skin crease.

Figure 6

Postoperative result at 6 weeks.