The dehiscent Hughes flap: outcomes and implications

Area of Science:

• Ophthalmology
• Plastic Surgery
• Reconstructive Surgery

Background:

• The modified Hughes procedure is a standard technique for lower eyelid defect reconstruction.
• It involves a tarsoconjunctival flap for the posterior lamella and a skin/skin-muscle flap for the anterior lamella.
• The conjunctival pedicle is typically divided after 3 weeks, pending vascularization.

Purpose of the Study:

• To review outcomes of patients experiencing premature dehiscence of the Hughes flap's conjunctival pedicle.
• To evaluate the functional and aesthetic results following traumatic dehiscence.

Main Methods:

• Retrospective review of eight patients over 15 years with premature flap dehiscence.
• Defect sizes ranged from 13-30 mm horizontally and 5-8 mm vertically.
• Dehiscence occurred 1-11 days postoperatively due to trauma; most cases healed spontaneously with antibiotic ointment.

Main Results:

• All eight patients achieved satisfactory outcomes.
• One patient with Sjögren's syndrome required secondary surgery for mild lagophthalmos and lower eyelid retraction.
• Follow-up ranged from 3 to 122 months (median 6.5 months).

Conclusions:

• Premature, traumatic dehiscence of Hughes flaps resulted in surprisingly good functional and aesthetic outcomes.
• Spontaneous healing with conservative management (erythromycin ointment) was effective in most cases.
• Findings suggest that elective division of the conjunctival pedicle might be feasible sooner than traditionally recommended.