Abstract
Purpose We describe a modification of Cutler-Beard's technique, using a contralateral tarsoconjunctival graft, in patients who underwent excision of large malignant tumors of the upper eyelid. Methods This is an interventional retrospective review (clinical study) of ten cases, with age range from 64 to 86 years (mean: 71.2 years ± 6.49) with malignant upper eyelid tumors, operated by the same surgeon (AB-G), between 2011 and 2016. The resulting defects were reconstructed using a modification of Cutler-Beard's technique. A tarsoconjunctival graft was harvested from the contralateral upper eyelid, with an extra 3 mm of conjunctiva from the superior edge of tarsus and was attached to the upper eyelid defect, different from that previously described. Follow-up ranged between 24 and 60 months (mean: 41.6 ± 9.87). Functional, cosmetic outcomes and postoperative complications were evaluated. Results No upper eyelid retraction, eyelid margin entropion, or graft retraction was observed in any of the cases. All of the patients were satisfied with the aesthetic result. Conclusion This technique allows us to safely inset a suitable graft on the ocular surface, with sufficient blood supply, resulting in a stable margin and good contour.
Highlights
In the reconstruction of large full-thickness upper eyelid defects, the technique described by Cutler and Beard in 1955 is still commonly used [1]
E reconstruction of upper eyelid defects is a major challenge as it has a number of considerations and difficulties not found in the reconstruction of lower eyelid defects and the techniques used are under constant review. e primary role of the upper eyelid is to protect the ocular surface, but it has a dynamic function; it requires a mucosal inner surface and a stable margin in order to maintain an adequate mobility and avoid abrasion of the ocular surface that could endanger visual quality [2,3,4]
We cannot forget that cosmesis is a very important factor for the patient, and poor eyelid reconstruction can lead to psychosocial morbidity; for a successful reconstruction, we need to maintain a good contour and appearance in addition to a good functional outcome
Summary
In the reconstruction of large full-thickness upper eyelid defects, the technique described by Cutler and Beard in 1955 is still commonly used [1]. We describe a new modification of the CBT, using a contralateral tarsoconjunctival graft attached to the upper eyelid defect different from that previously described by other authors. With this technique, we achieved a suitable graft placement overlying the ocular surface, adequate blood supply and, in the second step, a stable lid margin and a similar contour to the original state
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