Axial pattern upper eyelid myocutaneous flap for medial canthal reconstruction

Abstract

The medial canthal area has many functional and cosmetic peculiarities which provide challenges for surgeons. One of the best reconstructive options in this area is the Tripier flap. As originally described, it is a bipedicled flap. If unipedicled, the viability of each pedicle decreases as the length past the midline of the upper lid increases. In addition, many factors such as smoking, atherosclerosis, and diabetes may have adverse effects on viability. To improve flap vascularity the upper peripheral arcade vessels have been included in the upper eyelid medial pedicled orbicularis oculi myocutaneous flap. We used this axial pattern flap successfully in 11 heavy smokers to reconstruct medial canthal defects were. All flaps survived completely, with no wound-healing problems. This flap should be considered as a reliable option in medial canthal or lower eyelid reconstruction.