Orbicularis Muscle Mobilization in Eyelid Reconstruction

Reverse Modified Hughes Procedure for UpperEyelid Reconstruction

“…16 This is possibly because of the inevitable scarring resulting from placement of the skin graft onto the avascular tarsus. 16 However, the advancement of the wellvascularized orbicularis muscle between the skin and the tarsoconjunctival flap reduces scarring to produce a thicker and softer eyelid.…”

“…The orbicularis muscle, with its robust blood supply, enhances the viability of the reconstructed eyelid and could also reduce the period between the primary operation and the secondary revision of the flap. 16 The Hughes flap was traditionally left for 6 weeks, but several published studies revealed that vascularization of the reconstructed eyelid appears to occur more rapidly than was originally thought. Leibovitch and Selva 22 reported good results in 29 patients with early division of the Hughes flap at 1 week.…”

“…However, loss of the downward pull provided by the tarsoconjunctival flap during the healing period may result in the retraction of the reconstructed eyelid. 16 Therefore, we suggest that waiting enough time to stretch the flap properly may be necessary when there are extensive and deep defects, or the donor eyelid is tight, especially in young patients.…”

“…6 However, in the standard reverse modified Hughes procedure, there is no functioning orbicularis oculi muscle in the reconstructed eyelid, and it may induce some problems such as suboptimal eyelid closure and cicartricial change in the reconstructed eyelid. 15,16 We performed the reverse modified Hughes procedure with orbicularis mobilization for the reconstruction of extensive full-thickness defects of the upper eyelid, and this article reports the results obtained.…”

Eyelid Reconstruction

“…11 The orbicularis muscle has an excellent blood supply and enhances the mobility of the reconstructed lid. 12,13 Anterior lamellar defects can be reconstructed with a full-thickness skin graft. 14 Ideal donor sites include excess upper and lower eyelid skin and posterior auricular, preauricular, or supraclavicular skin.…”