Medial Canthal Reconstruction Using a Medially Based Upper Eyelid Myocutaneous Flap

Abstract

Periorbital reconstruction following skin cancer ablation represents a challenging problem. A thorough understanding of the complex periorbital anatomy is necessary to preserve lid function and protect the ocular surface. The medial canthal region represents the most difficult periorbital zone to reconstruct. This area has a complex anatomy involving both the medial canthus itself and the lacrimal apparatus. The authors present their experience with a versatile technique for reconstruction of the medial canthal periorbital region, namely, a medially based upper eyelid myocutaneous flap. In the 10 patients in whom this procedure was used, there was one partial and no complete flap losses. The authors believe that the medially based upper lid myocutaneous flap offers an excellent solution to the difficult problem of medial canthal periorbital reconstruction.

Orbicularis Oculi Myocutaneous Flap for Upper Cicatricial Ectropion

“…3,[11][12][13] Unipedicle or bipedicle flaps from the upper eyelid have been established in correcting lower eyelid ectropion, 4,14,15 but it has been addressed little on the upper cicatricial ectropion by upper orbicularis oculi myocutaneous flap despite its wide use. 4,13,15,16 The advantages making the orbicularis oculi myocutaneous flap a preferred choice among various reconstructive surgeons are unquestionable. It is supported with reliable blood supply, and provides well-matched skin color and texture.…”

“…15 The adequate blood supply also allows 180 degrees of rotation safely. 16 Slight venous congestion may be encountered in the early stage of skin flap formation, but the condition usually returns to normal within 2 to 3 days after the operation. No flap necrosis or change in the color has been observed.…”

“Pickaxe” Double Flap: A Useful “Tool” for Reconstruction of Deep Large Medial Canthal Defects—5-Year Experience and Brief Literature Review

“…Also relatively high rates of flap edema and venous congestion due to the narrow flap pedicle are encountered. Finally, the too thin skin of the flap is amenable to contracture and has a different texture to that of the medial canthus [11]. Chao et al have reported the use of a glabellar and a V-Y advancement of the orbicularis oculi myocutaneous flap for reconstruction of sizeable defects, despite the limited size of the orbicularis oculi myocutaneous flap.…”

Eyelid Reconstruction

“…18) and a medially based upper eyelid myocutaneous flap (Therapeutic: Level V Evidence). 42 (See Video, Supplemental Digital Content 2, which demonstrates total lower lid and medial canthus reconstruction with a tarsoconjunctival flap, Tripier orbicularis myocutaneous flap, and rhomboid flap, available in the "Related Videos" section of the full-text article on PRSJournal.com or, for Ovid users, at http://links.lww.com/PRS/A775.) Soft-tissue defects can also be reconstructed with a combination of pericranial flaps and full-thickness skin grafts.…”