Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Jun 18;7(3):507-11.
doi: 10.3980/j.issn.2222-3959.2014.03.22. eCollection 2014.

Total lower lid reconstruction: clinical outcomes of utilizing three-layer flap and graft in one session

Mohammad Taher Rajabi  1 , Fatemeh Bazvand  1 , Seyedeh Simindokht Hosseini  1 , Ali Makateb  1 , Mohammad Bagher Rajabi  1 , Syed Ziaeddin Tabatabaie  1 , Yalda Abrishami  1
Affiliations

Total lower lid reconstruction: clinical outcomes of utilizing three-layer flap and graft in one session

Mohammad Taher Rajabi et al. Int J Ophthalmol. .

Abstract

Aim: To report the clinical outcomes of utilizing a three-layer flap and graft in reconstruction of the lower lid in one session.

Methods: Seventeen patients with total or near total lower eyelid defect were included. The defects were reconstructed in three layers. Posterior lamella was reconstructed by using tarsoconjunctival free graft from the ipsilateral upper lid and periosteal flap from lateral orbital rim. Mobilization of residual orbicularis muscle provided a rich blood supply; and the anterior lamella was reconstructed by skin flap prepared from upper lid blepharoplasty as a one-pedicular or bipedicular bucket handle flap.

Results: The cause of lower eyelid defect was basal cell carcinoma in 15 patients and trauma in two of them. No intraoperative and postoperative complication occurred. Patients were followed from 10 to 15mo postoperatively. Cosmetic results were favorable in all patients and we had acceptable functional results. Thickness of the reconstructed tissue was a concern in early postoperative period.

Conclusion: Three-layer lower lid reconstruction in one session is an effective technique for total lower lid reconstruction with minimal complications and acceptable functional and aesthetic outcomes and can be considered as a safe alternative for the preexisting techniques.

Keywords: anterior lamella; blepharoplasty skin flap; lower lid reconstruction; orbicularis muscular flap; posterior lamella; tarsoconjuctival graft.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Stages of the reconstructive procedure
A: Total lower lid defect after excision of malignant lesion; B: Providing tarsoconjunctival free graft from upper lid; C: Suturing the tarsal plate and conjunctiva to lower lid; D: Providing lateral periosteal flap for complete reconstruction of posterior lamella; E: Creating muscular flap from residual orbicularis oculi muscle; F: Preparing skin flap from excessive skin of the upper lid blepharoplasty and rotating it from lateral part to place anterior to the previously reconstructed muscular bed.
Figure 2
Figure 2. Bipedicular bucket handle flap prepared from upper lid blepharoplasty.
Figure 3
Figure 3. Evolution of the appearance of the reconstructed lower eyelid in one of our cases
A: Before surgery; B: First day after surgery; C: 1wk later; D: 2mo later; E: 12mo later.
See this image and copyright information in PMC

References

    1. Goldberg RA, Kim JW, Shorr N. Orbital exenteration: results of an individualized approach. Ophthal Plast Reconstr Surg. 2003;19(3):229–236. - PubMed
    1. Gunalp I, Gunduz K, Duruk K. Orbital exenteration: a review of 429 cases. Int Ophthalmol. 1995–1996;19(3):177–184. - PubMed
    1. Rathbun J, Beard C, Quickert MH. Evaluation of 48 cases of orbital exenteration. Am J Ophthalmol. 1971;72(1):191–199. - PubMed
    1. Ben Simon GJ, Schwarcz RM, Douglas R, Fiaschetti D, McCann JD, Goldberg RA. Orbital exenteration: one size does not fit all. Am J Ophthalmol. 2005;139(1):11–17. - PubMed
    1. Rahman I, Cook AE, Leatherbarrow B. Orbital exenteration: a 13 year Manchester experience. Br J Ophthalmol. 2005;89(10):1335–1340. - PMC - PubMed

LinkOut - more resources