Reconstruction of Full-Layer Eyelid Defects and Marginal Loss With “∏” Flaps Pedicled With Arterial Arch of Palpebral Margin

Background: Surgical ablations of eyelid tumors, trauma, and burns, which encroach on the tarsal plate and eyelid margin, often create full-layer eyelid defects. However, the reconstruction of defects with marginal loss presents a challenge for plastic surgeons. In this report, we present a new modified surgical technique using “∏” flaps depending on the arterial arch of the palpebral margin to reconstruct eyelid defects with minimal loss. Methods: We reviewed 39 patients who underwent surgery using this technique from 2010 to 2021. “∏” Flaps, which include the tarsal plate, the conjunctiva, the orbicularis muscle, and the skin, were designed on 2 sides of the defect and then advanced horizontally to close the defect. Results: All the flaps survived with satisfactory functional and aesthetic outcomes. One minor complication occurred 1 month after the operation: dry eyes (n=1), which was improved 6 months later. Conclusion: This technique can be readily used for moderate and large full-layer defects (1/6 to 1/2 involvement) with marginal loss of the upper/lower eyelid, not exceeding the upper edge of the tarsal plate. By using neighboring tissue, reconstruction can achieve pleasing aesthetic outcomes. Level of Evidence: Level IV—therapeutic study.