Subcutaneous pedicled propeller flap for reconstructing the large eyelid defect due to excision of malignancies or trauma

Abstract

Large eyelid defect after excision of malignancies or trauma is difficult to reconstruct due to special structure and function of the eyelid. In this study, we aimed to present the outcomes of subcutaneous pedicled propeller flap for reconstructing the large eyelid defect after excision of malignancies or trauma. A retrospective review of patients diagnosed with eyelid defect due to excision of malignancies or trauma, and undergoing subcutaneous pedicled propeller flap for reconstructing the large eyelid defect, was conducted at our hospital. The clinical data were collected and analyzed. A total of 15 patients were included in the cases series. Nine patients were diagnosed with basal cell carcinoma, 3 patients with epidermoid carcinoma, and 3 patients with trauma. All the defects were successfully covered with this designed flap. There was no flap necrosis in all the cases. No functional problems were observed in all of the cases. At long-term postoperative follow-up, the average score of patients' satisfaction was good. This subcutaneous pedicled propeller flap is a feasible alternative technique for reconstructing the large eyelid defect after excision of malignancies or trauma. This flap option could avoid the use of free flaps for large defect.

Figure 1

The schematic diagram of the operation. (a) The subcutaneous pedicled propeller flap was designed according to the eyelid defect. (b) The subcutaneous pedicled propeller flap was cut. (c) The flap was rotated for 180° to cover the defect. (d) The flap was sutured to the defect, and the donor site was also sutured.

Figure 2

(a, b) A 52 years old female diagnosed with basal cell carcinoma. The tumor was resected and she was performed this subcutaneous pedicled propeller flap for reconstructing the large eyelid defect. (c) When the sutures were removed 7 days after the operation, the flaps survived well. (d) After 1 year of follow-up, the scar was not obvious, the appearance was satisfactory, there was no tumor recurrence, and no traction deformity.

Figure 3

(a) A 48-year-old woman had a basal cell carcinoma of the left lower eyelid. (b) The tumor was extensively excised, and the flap was designed. (c) Good appearance and normal function of the eyelid was obtained at the long-term follow up.

Figure 4

(a) A 49-year-old man had a large defect of upper eyelid due to car accident. (b, c) After a thorough debridement, the subcutaneous pedicled propeller flap was designed to reconstruct the large defect. (d) After postoperative 1 week, the sutures were removed and the wound healed well.

Figure 5

(a, b) A 5-year-old girl had a lower eyelid defect caused by a fall. After she was treated with skin grafting on the lower eyelid in the outer hospital, the skin contracture caused the lower eyelid ectropion. (c, d) We loosed the contracture of the tissue and designed the subcutaneous pedicled propeller flap to correct the defect. (e, f). The skin contracture and lower eyelid ectropion were successfully corrected and the wound healed well.