P139 Modified horizontal V-Y advancement flap for lower-eyelid defects: series of 300 cases

Abstract Lower-eyelid malignancies, specifically basal cell carcinomas (BCCs), are not uncommon. Excision of such lesions creates reconstructive challenges due to fewer surgical options and compromises in the dynamic expressivity of the face and facial aesthetic appearances. Direct closure is often restricted and it increases the incidence of ectropion if the lesion is > 0.5 cm in size. This clinical study aims to present a novel reconstructive technique and to report the authors’ experiences of full-thickness lower-eyelid defects after tumour resection. In total, 300 cases underwent surgical resection of lower-eyelid tumours between April 2015 and March 2020. Of these cases, 180 were in men and 120 in women, with an age range of 45–73 years. On initial histology, 180 of the patients had nodular BCC, 30 pigmented BCC, 70 micronodular BCC, 6 BCC morphoeic variant, 10 squamous cell carcinoma (SCC) and 4 adnexal tumours. The average diameter of the defects was 1.5 cm. They were immediately repaired by an island pedicle flap (V-Y advancement flap) with high height-to-width ratio horizontally shaped from beneath the lateral canthus to the medial lower-lid defect. The mean procedure time was 30 min and the patients were followed up for 24 months on average. Advancement of the lower-eyelid subunit by means of a relatively long horizontal V-Y flap was performed without postoperative complications or the development of ectropion, and scars were nearly unremarkable at follow-up. The aesthetic results were judged excellent by both the patients and the blinded panel of independent dermatological surgeons. No recurrences were reported. In this study, we report a modified technique of the horizontal V-Y advancement flap as a simple and reliable alternative to repair moderate-size lower-eyelid defects, with satisfactory functional and aesthetic results in the long term.