Repeat tarsoconjunctival flap with limited tarsal support in lower eyelid reconstruction

PURPOSE: The Köllner-Hughes tarsoconjunctival flap is a well-known reconstructive workhorse for the repair of full-thickness lower eyelid defects but repeat use for repair of the same eyelid has been seldom reported. METHODS: Over a fifteen-year period, two patients were identified to have undergone a successive tarsoconjunctival flap procedure following recurrent malignancies by a single oculoplastic surgeon. Using this successive technique required careful dissection in scarred tissue planes and only 1.5 mm of vertical tarsal height incorporated into the tarsoconjunctival flap. RESULTS: Despite limited residual tarsal support in the flap, both cases achieved adequate lid position, corneal protection, and lid stability on long-term follow up, with no evident donor site complications at 6 months and 4 years' follow-up respectively. CONCLUSIONS: Repeat procedures may represent a viable reconstructive option for recurrent eyelid defects despite minimal tarsal support when alternative approaches carry greater morbidity.