Reconstruction of periorbital defects using a modified Tenzel flap

Abstract

Background: Extensive eyelid defects are extremely challenging to reconstruct. Although numerous procedures for reconstructing periorbital defects have been proposed, no method is universally used. However, the Tenzel flap is the most commonly used technique to reconstruct eyelid defects affecting one-third to two-thirds of the eyelid.

Methods: Recognizing the usefulness of the Tenzel method, we adapted it to reconstruct larger defects around the eyes. Seven patients underwent reconstruction with a modified Tenzel flap with an extended concept after wide excision of a malignant skin lesion. The main difference from the conventional method is that the modified Tenzel flap includes the medial portion of the lower lid defect. The design of a modified Tenzel flap begins as a semicircle at the lateral canthal area, in the same way as a classical Tenzel flap, and extends medially along the subciliary line to cover the defect on the medial lower eyelid. The follow-up time ranged from 3 to 28 months.

Results: All flaps survived and healed well, with minimal scarring and natural palpebral outlines.

Conclusion: Compared to traditional procedures, the modified Tenzel flap has several advantages, including a one-stage operation, a less noticeable scar, and effective prevention of complications such as lower eyelid ectropion.

Keywords: Eyelids; Skin neoplasms; Surgical flaps.

Fig. 1.

A 70-year-old man with an 11×6 mm basal cell carcinoma on the medial side of the eyelid-cheek junction (case 1). (A) Preoperative photograph. (B) Intraoperative photograph showing the defect immediately after excision of the tumor. The defect measured 25×15 mm. (C) Flap elevation began at the superior margin of the flap and proceeded caudally. Superiorly, the plane of elevation was just above that of the orbicularis muscle. Dissection proceeded toward the inferolateral corner of the flap in the subcutaneous plane until sufficient flap mobilization was achieved. (D) The patient’s appearance at 20 months after reconstruction. A favorable aesthetic outcome was observed, with a hardly noticeable scar on the lower eyelid and cheek.

Fig. 2.

A 60-year-old woman with a 5×5 mm basal cell carcinoma on the lateral upper eyelid (case 2). (A) Preoperative photograph. (B) The flap was elevated in the subcutaneous plane and advanced superomedially to close the defect. (C) Immediate postoperative view of the reconstruction using a modified Tenzel flap. (D) Appearance at 3 weeks after reconstruction. An aesthetically gratifying result was observed, with a natural upper lid line.