Lid reconstruction for large lower eyelid defects (extending into canthus) with Hughes flap and skin graft - possibilities and limitations

Abstract

The aim of lid reconstruction is restoration of function, comfort and cosmesis. Large defects of the lower eyelid especially with extension into the canthus are a surgical challenge. A Hughes flap combined with a skin graft is a good option not only for central defects of the lower eyelid. This article presents the surgical outcome in a series of 45 patients with large full-thickness lower eyelid defects partially extended into the canthus after tumour excision. These patients underwent reconstructive eyelid surgery using a Hughes flap, autogenous skin graft, partially combined with other surgical techniques. RESULTS after division, possibilities and limitations are shown in this article. The analysis was based on photo documentation, surgery reports and patient statements. In all cases surgery was performed by the same surgeon. 45 patients were identified during a 3-year interval. The average age at the time of eyelid reconstruction was 70.6 years (range 38-94 years). Lid defects extending into the canthus were observed in 20 patients (9 inner/11 outer canthal region). The average size of lid defect was 17 mm and ranged from 9 to 28 mm horizontally. 26 patients showed defects ≥ 15 mm; 16 of them were identified with an extension into the canthus (8 inner/8 outer). Flap complications occurred in 14 patients after flap division; 8 with primary canthal involvement. After Hughes procedure, flap division and correction of complications (epilation, debulking, resuturing) 44 patients showed a very good lower lid position with good functional and cosmetic results. Due to incomplete lid closure 1 patient developed severe complications of corneal surface. Follow-up time ranged from 5 to 10 months (on average 6 months). In 6 patients the Hughes procedure was combined with other reconstructive techniques. In cases of large lower lid defects (even with extension into the canthus) the Hughes flap combined with skin graft and other reconstructive procedures leads to a well tightened lid position, shows a high grade of patient satisfaction although the complete blepharorrhaphy is necessary for 6 weeks and complications occur. For one-eyed patients a one step surgical procedure should be preferred.