“Reconstruction of Large Full-Thickness Medial Lower Eyelid Defects Using a Medially-Based Tarsoconjunctival Pedicle Flap”

Reconstruction of large full-thickness medial lower eyelid margin defects often requires centrally-based tarsoconjunctival pedicle flaps from the ipsilateral upper eyelid in combination with anterior lamellar grafting. However, centrally-based flaps may result in temporary obstruction of the visual axis in the affected eye. We present a novel modified surgical technique utilizing a medially-based tarsoconjunctival pedicle flap from the upper eyelid for the reconstruction of large full-thickness medial lower eyelid defects. A tarsoconjunctival flap was mobilized and hinged medially by the conjunctiva from the upper eyelid with rotation into the lower eyelid defect. This surgical technique was utilized in four cases with medial lower eyelid defects involving 60-65% of the eyelid after basal cell carcinoma excision. All cases resulted in successful reconstruction of the defect without graft failure, wound dehiscence, or lagophthalmos. Medially-hinged tarsoconjunctival pedicle flaps are an effective technique for the reconstruction of large full-thickness medial lower eyelid defects. This procedure may be considered especially in patients with similar defects who cannot tolerate ocular occlusion.