Reconstruction of Upper Eyelid Defects Secondary to Malignant Tumors with a Newly Modified Cutler-Beard Technique with Tarsoconjunctival Graft

Abstract

Purpose. We describe a modification of Cutler-Beard’s technique, using a contralateral tarsoconjunctival graft, in patients who underwent excision of large malignant tumors of the upper eyelid. Methods. This is an interventional retrospective review (clinical study) of ten cases, with age range from 64 to 86 years (mean: 71.2 years ± 6.49) with malignant upper eyelid tumors, operated by the same surgeon (AB-G), between 2011 and 2016. The resulting defects were reconstructed using a modification of Cutler-Beard’s technique. A tarsoconjunctival graft was harvested from the contralateral upper eyelid, with an extra 3 mm of conjunctiva from the superior edge of tarsus and was attached to the upper eyelid defect, different from that previously described. Follow-up ranged between 24 and 60 months (mean: 41.6 ± 9.87). Functional, cosmetic outcomes and postoperative complications were evaluated. Results. No upper eyelid retraction, eyelid margin entropion, or graft retraction was observed in any of the cases. All of the patients were satisfied with the aesthetic result. Conclusion. This technique allows us to safely inset a suitable graft on the ocular surface, with sufficient blood supply, resulting in a stable margin and good contour.

Surgical Strategies for Eyelid Defect Reconstruction: A Review on Principles and Techniques

“…The tarsoconjunctival grafts taken from healthy eyelids are the gold standard tissue for posterior lamellar reconstruction [ 50 ] and have been used to repair defects of up to 75% of the eyelid length [ 51 , 52 ]. Typically, the size of the donor tarsoconjunctival graft ranges from 4 to 5 mm vertically and 8–16 mm horizontally, and preservation of at least 4 mm of the tarsus is recommended to avoid complications.…”

“…Tarsal grafts can be regarded as tarsoconjunctival grafts without the conjunctival lining. Free tarsoconjunctival grafts or tarsal grafts are often used in combination with other tissue flaps to provide a blood supply for the grafts in full-thickness defects [ 51 , 53 , 54 ]. When free tarsal grafts are used for posterior lamellar reconstruction, the conjunctival lining is often absent, leaving it to be gradually re-epithelialized from the marginal conjunctiva.…”

“…Similar to the Hughes tarsoconjunctival flap, this flap also impairs vision and requires secondary flap division; unlike the Hughes flap, this flap is a full-thickness flap containing skin, muscle, and conjunctiva. Due to the lack of tarsus within this flap, an additional tarsus substitute, such as free auricular cartilage [ 31 , 90 ], contralateral tarsus, tarsoconjunctiva [ 51 , 91 ], or commercial dermal matrix [ 92 ], is required to reconstruct the upper eyelid tarsus to prevent postoperative retraction and entropion. Upper eyelid retraction and entropion are common complications of this technique [ 91 ].…”

How and when of eyelid reconstruction using autologous transplantation

“…Yazici et al [ 23 ] recently described the association of a TC graft with a bilobed local flap for the upper eyelid. Bengoa-González et al [ 24 ] described the use of the graft to complete and modify the Cutler-Beard technique for the upper eyelid. The TC graft gives stability to the new upper eyelid, avoiding retraction caused by scarring.…”

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

“… 6 , 7 Recently, some modifications of these techniques have been reported. 8 , 9 , 10 Additionally, the switch flap is a useful method in that it uses autologous tissue for posterior lamella reconstruction, similar to the Hughes or Cutler-Beard techniques. 11 , 12 However, all aforementioned surgical procedures are two-stage surgeries.…”