Reconstruction of a large lateral upper and lower eyelid defect using a Mitek screw, Fricke flap and skin grafts from the eyelid

Abstract

Periocular basal cell carcinomas (BCC) are commonly excised and reconstructed by oculoplastic surgeons. We describe, with the aid of pictures and diagrams, a multimodal reconstruction of a large defect involving the lateral canthal angle, one-third of the upper eyelid and half of the lower eyelid with loss of lateral orbital periosteum. The eyelids were anchored with the novel use of a Prolene suture tethered to a titanium screw at the lateral orbital rim, providing structural stability. A Fricke flap was mobilised to reform the anterior lamella of the upper and lower eyelids, with the addition of an upper eyelid advancement flap and a small skin graft. The patient has had an excellent result at 15-month follow-up.

Keywords: Dermatology; Ophthalmology; Plastic and reconstructive surgery; Skin cancer.