The Use of Composite Lid Graft and the Adjacent Temporal Myocutaneous Tissue with Orbicularis Muscle Mobilization for Full-Thickness Total and Subtotal Upper Lid Reconstruction

Abstract

Purpose: To evaluate the use of a lateral full-thickness upper eyelid graft and the adjacent myocutaneous tissue in the temporal area with mobilization of the orbicularis muscle as a single-stage procedure for reconstruction of full-thickness total and subtotal upper eyelid defects. Methods: Twelve patients with extensive basal cell carcinoma were included. In seven patients, the tumor involved the inner canthus and at least the medial one-fourth of both upper and lower eyelids. In five patients, the tumor involved more than two-thirds of the upper eyelid. Following resection of the tumor with a safety margin, a 16-mm graft from the normal upper eyelid and its adjacent myocutaneous tissue in the temporal area was used in reconstruction of the defect in the upper eyelid, without affecting the function or the esthetic appearance of the donor upper eyelid. In all cases, the remaining orbicularis in the recipient bed was mobilized as a bipedicle flap, advanced inferiorly and sutured to the graft. Results: All the grafts have taken. The functional and esthetic results in both donor and recipient upper eyelids were acceptable during a follow-up period of 6–50 months. In 8 patients (67%), the cilia of the composite lid portion of the graft have only partially taken. Conclusion: This single-stage procedure with a single donor site may represent a simple alternative to more complicated procedures described for total full-thickness upper eyelid reconstruction or subtotal reconstruction associated with medial lower eyelid defects.