A technique for posterior lamellar reconstruction of upper-eyelid marginal defect

Abstract

We report a technique for a posterior lamellar reconstruction of upper-eyelid marginal defects under general anaesthesia. The technique included a tarso-conjunctival muscular flap with double horizontal incisions and quantification in eyelid closure. An 83-year-old female presented with a left upper-eyelid marginal sebaceous carcinoma of 4 × 5 mm. A 5-mm safety margin was set for excision of the tumour. A 3-mm high tarsus remained after removal of the tumour. The tarso-conjunctival muscular flap, including Muller’s muscle and the levator aponeurosis, was then formed into an oblong shape. The distal tarsal flap was fixed to both sides of the original tarsus. Two horizontal incisions, the distal one set from the lateral side, were formed to elongate the flap. The incisions were extended until the upper-eyelid margin remained stable after a forcible eyelid closing under finger force. Anterior lamellar reconstruction was performed with a vertical advancement flap with Burrow’s triangles. After closing the wound with two additional sutures to reform the skin crease, three tarsorrhaphy sutures were set. These were removed a week later. The upper eyelid then opened appropriately and closed without lagophthalmos, and the curvature was within a permissible range. A posterior lamellar tarso-conjunctival muscular flap with double horizontal incisions and quantification with eyelid closure using finger force were useful for reconstructing a posterior lamellar defect under general anaesthesia.