Extended Superolateral Periosteal Flap for Single-Stage Total Lower Eyelid Reconstruction

Abstract Total lower eyelid reconstruction requires restoration of both lamellae and prevention of postoperative malposition. Traditional two-stage approaches often require a prolonged period of monocular vision. This report describes an extended superolateral periosteal flap harvested along the superior orbital rim to within 2-3 mm of the supraorbital notch, achieving a 35-mm length for single-stage total lower eyelid reconstruction. A 71-year-old woman with basosquamous carcinoma involving the entire lower eyelid underwent excision with 5-mm margins, creating a 30 × 35 mm defect. The periosteal flap was secured to the medial canthal tendon, and the conjunctiva was advanced to line the flap. The anterior lamella was reconstructed using a cheek rotation flap. Early follow-up demonstrated satisfactory eyelid position with transient chemosis. At 3 months, a stable margin position was maintained, and no early ectropion, entropion, symblepharon, or lagophthalmos was observed. Compared with free tarsoconjunctival grafts, a vascularized periosteal flap provides intrinsic blood supply and may support tissue survival when recipient bed vascularity is limited. This extended periosteal flap may serve as a single-stage alternative for complete lower eyelid defects while preserving binocular vision during recovery. Longer-term follow-up was limited due to the patient's death from an unrelated medical condition.