Abstract
Aims: To evaluate the usefulness of orbicularis bi-pedicle flap, a simple surgical technique to reconstruct shallow, upper or lower eyelid defects with loss of more than two-thirds of the lid tissue. Materials and Methods: This prospective interventional study was conducted at a two tertiary referral centers in Lahore, Pakistan from Jan 2011 - Dec 2018. 17 consecutive cases were included: 4 primary, 9 with recurrent tumour and 4 secondary cases with an excised tumour and eyelid defect. The upper lid was affected in 6 cases and lower lid in 11 cases. The median age of patients was 62 years (range 45 - 71 years), with 9 female and 8 male patients. The posterior lamella was reconstructed by mobilising forniceal conjunctiva while donor sclera was used to replace the tarsus. To reconstruct anterior lamella, orbicular bi-pedicle flap was mobilised, covered by a free skin graft. Post-operative follow-up was after 1, 2 weeks and then after 1, 3, 6 months and 1 year. At each visit, functional, aesthetic, visual outcome and patient satisfaction was assessed. Results: Patient satisfaction was 100%. Lagophthalmos in 3 cases (27%), 2 mm lid retraction in 2 cases (18%) following upper lid reconstruction. No complication noted after lower lid reconstruction. Conclusions: Orbicularis bi-pedicle flap is a simple, single-staged technique, with short learning curve and minimal complications. It is particularly useful in single-eyed patients. Keywords: Lid reconstruction, Lid tumor excision, Lid margin defects, Orbicularis bipedicle flap.
Highlights
An eyelid defect may present to an oculoplastic surgeon following trauma, tumour excision, irradiation or as a congenital coloboma
The upper lid crease is an important landmark; its symmetry with the opposite upper lid should be kept in mind during an upper lid reconstruction
We describe here a simple surgical technique to reconstruct full-thickness defects of either the upper or the lower eyelid, involving more than 2/3r d of the lid length
Summary
An eyelid defect may present to an oculoplastic surgeon following trauma, tumour excision, irradiation or as a congenital coloboma. For the proper management of an eyelid defect, a thorough knowledge of the surgical anatomy of eyelids is mandatory. 2 The eyelids are made up of two lamellae, the anterior and a posterior. The anterior lamella comprises of a thin, relaxed skin, without any subcutaneous tissue so as to permit a full excursion of eyelids during blinking. Scars can be hidden in incisions made parallel to or within the skin creases (the skin tension lines), which are present at right angles to the direction of action of the underlying muscle. The upper lid crease is an important landmark; its symmetry with the opposite upper lid should be kept in mind during an upper lid reconstruction
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