Orbicularis oculi myocutaneous advancement flap for upper eyelid reconstruction

Reconstruction of large full-thickness defects of the upper eyelids is challenging because of their complex anatomy and specialized functions. The authors present and discuss a new, simple surgical technique for upper eyelid reconstruction. This is a single-stage procedure and has produced satisfactory to excellent results in the authors' patients. It presents the reconstructive surgeon with several advantages over other techniques.

The eyelid tumor is excised surgically until clear margins are obtained. The V-shaped orbicularis oculi myocutaneous advancement flap is marked on the remaining superior eyelid tissue and mobilized, leaving the base of the pedicle intact with submuscular tissue attachment. Posterior lamella reconstruction is performed with mucoperiosteal graft harvested from the hard palate in patients with full-thickness defects. Then, the flap is advanced to the defect and the donor site is closed primarily.

Eight patients, aged 17 to 72 years, have been operated on with this technique for upper eyelid reconstruction. Follow-up included assessment of position, closure, length of palpebral rim, eyelid opening, aesthetic balance, presence of corneal erosion, ulcer or entropion, levator function, and donor-site morbidity. The flap was viable in every patient, without total or partial necrosis. No patient required surgical revision. The oncologic result was good, and no recurrence was noted.

This method is a simpler, single-stage operation; does not damage the lower lid; provides a thin, mobile eyelid; and, above all, is less invasive than other techniques, and at the same time allows a good functional and aesthetic reconstruction.