Novel tarsal flap procedure proves effective for lower eyelid defects

A new surgical technique that involves using sliding tarsal flaps proved effective for reconstructing full-thickness lower eyelid defects in a small study.

Jean-Louis deSousa, FRANZCO, of the Queen Victoria Hospital in East Grinstead, England, and colleagues reviewed outcomes for 12 patients treated with the technique for shallow, full-thickness lower eyelid defects resulting from prior Mohs excision of eyelid malignancies. They published their results in the January/February issue of Ophthalmic Plastic and Reconstructive Surgery.

For the technique, surgeons reconstructed the posterior lamella by obliquely incising the residual tarsus, creating medial and lateral tarsal flaps. They then overlapped these flaps obliquely to tighten the eyelid and reconstruct a tarsus approximating normal height, the authors reported. Finally, surgeons conventionally reconstructed the anterior lamella defect using either local flaps or free grafts.

"The advantages of this approach are its simplicity, utilization of preserved tissue and avoidance of the morbidity associated with more complex procedures," the authors noted.

Preoperatively, eyelid defects ranged from 25 mm to 40 mm horizontally and 20 mm to 35 mm vertically; tarsal defects ranged from 18 mm to 27 mm horizontally and 2 mm to 3.5 mm vertically. After surgery, all patients had stable eyelid margins and good aesthetic appearances, they said.

Complications were minimal and included two patients who experienced mild eyelid retraction that required no intervention. One other patient developed lower eyelid entropion at 9 months postop, according to the study.