Reconstruction of Large Upper Eyelid Defects With Bilobed Flap and Tarsoconjunctival Graft

Abstract

Purpose: To describe the reconstruction of large upper eyelid defects with bilobed flap and tarsoconjunctival graft. Methods: The medical records of 5 patients who underwent upper eyelid tumor excision and eyelid reconstruction with a bilobed flap were reviewed. Various parameters, including demographic and clinical data, defect diameter, primary defect closure, complications, and follow-up time, were recorded. After tumor excision, the posterior lamella was reconstructed with an autologous tarsoconjunctival graft and anterior lamella with a superiorly based lateral bilobed flap. Results: All 5 patients (3 women, 2 men; age: 42–87 years) had malignant epidermal (n = 2) or adnexal (n = 3) tumors. Mean excisional defect diameter was between 18.5 and 25 mm. In all patients, the anterior lamellar defect was closed primarily with a bilobed flap. After surgery, a total of 4 complications occurred in 3 patients. One patient required orbital exenteration because of tumor recurrence. In the other patients, the functional and esthetic results were satisfactory. Follow-up time ranged from 4 to 102 months. Conclusion: Lateral periorbital bilobed flap can be a good alternative for the single-stage reconstruction of large upper eyelid defects.

Reconstruction of a Traumatic Large Upper Eyelid Avulsion with Tarsoconjunctival Graft and Rotational Flap: A Surgeon’s Preference

“…The most common is the Cutler-Beard procedure [6] , a two-step procedure where a full-thickness bridge flap raised from the lower eyelid is advanced to the upper eyelid defect, which will be divided after a few weeks. [7] The Cutler-Beard procedure has become the mainstay of large upper eyelid reconstruction. However, many have pointed to the lack of rigid support in the upper eyelid posterior lamella as one of its disadvantages, which causes entropion and ocular surface abrasions that can lead to eye irritation.…”

Evaluation of the postoperative course of East Asian eyelid reconstruction with free tarsoconjunctival graft transplantation: A Japanese single-centre retrospective study

“…Furthermore, recent studies reported that a large defect of the upper eyelid was reconstructed by one-stage surgery using FTG transplantation. 22 , 23 Postoperative complications were observed in 40–60% of these reports, and Patrinely et al. 24 noted that reoperation was performed in about 35% of these cases.…”

Posterior lamella substitutes in full-thickness eyelid reconstruction: a narrative review

“…However, it still needs further validation by recruiting more patients and following up extended period. As for the reconstruction of sizeable upper eyelid defects, Yazici et al (22) reported a bilobed flap combined with a tarsoconjunctival graft from the contralateral upper eyelid. That was demonstrated to be a good alternative for the single-stage procedure for sizeable upper eyelid defects.…”