Single-stage repair of large full thickness lower eyelid defects using free tarsoconjunctival graft and transposition flap: experience and outcomes

Abstract

ABSTRACT Background Lid-sharing approaches are often advocated for repair of large full thickness lower eyelid defects, however result in temporary visual obstruction and the need for a second-stage procedure. The authors describe and report outcomes using a one-stage technique utilizing a free tarsoconjunctival graft (TCG) and musculocutaneous transposition flap (MCT) to repair defects up to 90% of the lower eyelid. Methods A retrospective chart review on patients that had undergone full thickness lower eyelid reconstruction using a TCG and MCT between the dates of 1/1/2015 to 3/1/2020 was performed. Demographic and clinical information including indication for repair, size of defect, post-operative complications, and outcomes were recorded and analyzed. Results Six cases of lower eyelid reconstruction using this technique were identified. Fifty percent were male, average age was 61.3 years (range 36–91, SD = 18.9), and follow up was 36.7 weeks (range 3–129, SD = 48.1). All defects were due to malignancy (4/6 for basal cell carcinoma, 1/6 each for sebaceous cell carcinoma and merkel cell carcinoma). Average horizontal defect size was 80% of lower eyelid width (range 57%-90%, SD = 12.3), while average vertical defect size was 8 mm (range 5–10 mm, SD = 1.7). There were no instances of post-operative infection, lid malposition, or dehiscence. A pyogenic granuloma was noted in one case and was managed with excision. Conclusion A single-stage procedure using a TCG and MCT can be used to repair laterally based full-thickness lower eyelid defects up to 90% with satisfactory outcomes and few complications.