Total upper and lower eyelid reconstruction using periosteal flap canthoplasty combined with auricular cartilage and oral mucosa grafts

Abstract

Extensive full-thickness defects of both the upper and the lower eyelids continue to be a challenge for reconstructive surgeons. Ectropion of the lower eyelid and an unnatural canthal shape are pitfalls to be avoided in total eyelid reconstruction. We here present a case in which an extensive full-thickness defect of the upper and lower eyelids after tumor resection was successfully reconstructed by means of periosteal flap canthoplasty from the infraorbital margin. A 73-year-old woman had in situ melanoma on her left eyelids. The lids were almost completely removed as a result of tumor resection. The conjunctival defect was covered with oral mucosa. And the tarsal layer was reconstructed with auricular cartilage. A periosteal flap pedicled at the origin of the lateral canthal tendon was harvested from the infraorbital margin. The flap was fixed with sutures on the cartilage graft for the lower eyelid. The cartilage graft for the upper eyelid was sutured laterally on the basal portion of the periosteal flap as the lateral canthus. The skin defect of the upper eyelid was covered with a bipedicled orbicularis oculi flap and skin graft. The lower eyelid was reconstructed with a combination of an angular artery transposition flap and a cheek rotation flap. Thirteen months after the surgery, the reconstructed eyelids had good function without ectropion. And the reconstructed canthus had a natural sharp shape. Total eyelid reconstruction using periosteal flap canthoplasty combined with auricular cartilage and oral mucosa grafts is useful for extensive full-thickness defects of the upper and lower eyelids. Level of evidence: Level V, therapeutic study.