Surgical Treatment with Locoregional Flaps for the Eyelid: A Review

Abstract

Reconstruction of the eyelids after skin cancer excision can be challenging. Surgical treatment options are multiple; deep anatomy knowledge of lamellar components is mandatory to choose the most adequate surgical planning. Eyelids' role in vision and social relationship is critical; both function and aesthetics are tough to restore. Using a flap provides a satisfying texture and colour match with adjacent tissues and ensures short contraction during healing; furthermore, grafts are sometimes necessary to achieve pleasing results. Hundreds of surgical techniques have been described aiming for eyelid reconstruction; in our paper, we want to provide for our audience the most reliable and useful procedures for subtotal and total eyelid reconstruction following NMSC full-thickness excision.

Figure 1

Direct closure for a defect of 25% or less of eyelid's width. Free-tension closure is achieved.

Figure 2

Oral mucosa graft for posterior lamella reconstruction. A graft of oral mucosa is harvested from the cheek (a). The graft is used for posterior lamella reconstruction (b).

Figure 3

The V-Y myotarsocutaneous flap. Flap is designed on the lateral canthal region (a). Tumor excision, the medial side of the flap corresponds to lateral margin of the defect, and the superior edge follows the line of the superior palpebral fold (b). Flap advancement and donor-site closure in a V-Y fashion (c).

Figure 4

Fricke flap designed for total lower eyelid reconstruction (a). The transposition flap is raised and sutured (b). Donor site is closed (c).

Figure 5

Fricke flap for subtotal upper eyelid reconstruction (anterior lamella). Intraoperative marking of Fricke flap, the posterior lamella has already been reconstructed using a buccal mucosa graft (a); the transposition flap and donor site are sutured (b).

Figure 6

Chondromucosal flap. Preoperative picture, tumor excision is going to involve the whole width of upper eyelid (a). Intraoperative marking of chondromucosal flap, lateral nasal wall (b).

Figure 7

Chondromucosal flap. The flap is raised on his pedicle (a). The flap is covered with a full-thickness skin graft. (b).

Figure 8

Chondromucosal flap. Postoperative view at 12 months.

Figure 9

Tenzel flap. The tumor is excised. Starting at the lateral canthus a line is drawn with a semicircular pattern towards the lateral eyebrow (a). The lateral edge of the defect is advanced (b) and sutured (c) to the medial one.

Figure 10

Mustardé flap. NMSC of upper and lower eyelid (a). Orbital exenteration and reconstruction with Mustardé flap were performed. Postoperative view at 2 months (b).