Medial and lateral canthal reconstruction with an orbicularis oculi myocutaneous island flap

Abstract

Background: The eyelid and canthal areas are common locations for cutaneous tumors. The medial canthus includes, among many other apparatuses, the canthal tendon and lacrimal canaliculi, and its characteristic thin and supple skin is hard to mimic and restore using tissue from other regions. Accordingly, reconstruction of the canthal area can prove challenging for surgeons. Although various methods, such as skin grafts and local flaps from adjacent regions, have been utilized for reconstructive purposes, they present known disadvantages. However, we were able to successfully reconstruct both lateral and medial canthal area defects by using orbicularis oculi myocutaneous island flaps.

Methods: Our study included seven patients who underwent medial or lateral canthal region reconstruction, using orbicularis oculi myocutaneous island flaps, between 2011 and 2014, following either cutaneous tumor excision or traumatic avulsion injury.

Results: Five patients had basal cell carcinoma, one had squamous cell carcinoma of the eyelid, and one had sustained a traumatic avulsion injury of the eyelid and canthal area. Entire flap loss was not observed in any patient, but one-a heavy smoker-showed partial flap loss, which healed with secondary intention and yielded acceptable results. Donor site morbidity was not observed, and all patients were satisfied with their surgical outcomes.

Conclusions: The canthal regions can be successfully reconstructed with orbicularis oculi myocutaneous island flaps. These flaps offer several key advantages, including similarity in texture, color, and thickness to the recipient site and a negligible incidence of donor site morbidity.

Keywords: Carcinoma; Eyelids; Myocutaneous flaps.

Fig. 1

Elevation of the orbicularis oculi myocutaneous island flap (A) Elevation of a laterally based orbicularis oculi myocutaneous flap to cover defects in the lateral lower eyelid or lateral canthal area. The musculocutaneous perforator, indicated with a dotted line, enters at an approximately 4-mm horizontal distance from the lateral canthus. The muscle pedicle is 1-cm wide. (B) Elevation of a medially based orbicularis oculi myocutaneous flap to cover the defects in the medial lower eyelid or medial canthal area. The musculocutaneous perforator, indicated with a dotted line, enters at an approximately 4-mm horizontal distance from the medial canthus.

Fig. 2

A case involving the use of a medially based myocutaneous flap (A) A skin defect (10×9 mm) after excision of basal cell carcinoma. (B) Elevation of a medially based myocutaneous island flap from the ipsilateral upper eyelid. (C) Immediate postoperative view. (D) View of neutral gaze at 6 months after surgery. (E) View of eye closure at 6 months after surgery.

Fig. 3

A case involving the use of a laterally based myocutaneous flap (A) A skin defect (25×7 mm) after excision of basal cell carcinoma. (B) Elevation of a laterally based myocutaneous island flap from the upper eyelid. (C) Subdermal tunneling of the flap to the site of the defect. (D) Immediate postoperative view. (E) View at 6 months after surgery.

Fig. 4

Vascular supply of the eyelids Musculocutaneous perforators arising from the peripheral arcade on the upper eyelid tarsal plate can be used as pedicles for the orbicularis oculi myocutaneous island flaps.