Temporally Based Orbicularis Oculi Myocutaneous Flap for Pediatric Postexcisional Cicatricial Lower Eyelid Ectropion

This report describes a pediatric patient with a congenital melanocytic nevus of the lower eyelid who developed cicatricial ectropion after 2 prior local excisions at an outside institution. Upon referral, definitive reconstruction was performed using a temporally based orbicularis oculi myocutaneous (OOMC) flap. The flap was designed along the lateral canthus-temporal direction to provide an upward traction vector and additional muscular support. The temporally based OOMC flap provides adequate tissue thickness and a favorable color match resembling the lower eyelid. The superior border was aligned with the lower eyelid margin, while the inferior border was gently curved to redistribute tension and minimize the risk of recurrent ectropion. Postoperatively, flap perfusion was stable and ectropion was successfully corrected. During follow-up, the eyelid margin position remained stable, with satisfactory symmetry. This case suggests that when lower eyelid lesions involve the anterior and middle lamellae or are complicated by cicatricial traction, early reconstruction using a temporally based OOMC flap can provide reliable structural restoration and functional stability.