Total and near‐total lower eyelid reconstruction with prefabricated orbicularis oculi musculocutaneous island flap

Abstract

Full thickness lower lid defects are frequently encountered during daily practice. The unique anatomy of the eyelids hinders reconstructive efforts. The aim of the study is to develop an effective and easy procedure for the reconstruction of full thickness defects of the lower eyelid. Here we present six cases, which we treated with an orbicularis oculi musculocutaneous island flap prefabricated with a chondrocutaneous graft. Five of the six cases suffered from tumors, while one had congenital coloboma of the lower lid. A chondrocutaneous graft harvested from the ear was placed under the orbicularis oculi musculocutaneous flap. Three weeks later, the defect was created and the prefabricated flap was transposed to the defect. Two cases had superficial distal skin loss and one had prolonged oedema. No major complication or tumor recurrence was seen. Using this method, the principle “replace with like” is fulfilled. Orbicularis oculi musculocutaneous island flap prefabricated with postauricular chondrocutaneous composite graft seems to be a feasible method for the reconstruction of full thickness defects of the lower eyelid with its low donor morbidity and good outcomes.

Case report: Lower eyelid Reconstruction with the rotation flap pedicled by orbicularis oculi muscle

“…In the procedure described by Barin and Cinal, a musculocutaneous flap based on the OO was designed to repair lower-eyelid defects ( 9 ). A chondrocutaneous graft was prefabricated under a pre-septal portion of the OO, and then a musculocutaneous island flap was elevated with the graft after 3 weeks.…”

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

“…When the residual orbicularis muscle is insufficient, a frontalis muscle flap can be used as the center of the “sandwich” instead, and the motor function of the eyelid can also be restored to a certain extent [ 102 ]. In addition, tissue fabrication techniques have been applied for fabricating composite grafts for complex eyelid defect reconstruction, such as a chondromucosal-auricular graft [ 103 ], chondrocutaneous-myocutaneous composite graft [ 61 ], two-layer skin-cartilage unit [ 104 ], three-layer skin-cartilage-mucosal unit [ 105 , 106 ], or skin-tendon-mucosal unit [ 45 ].…”