Upper eyelid reconstruction with forehead galeal flap

Upper lid reconstruction depends on the size of the defect, and a general consensus holds that partial-thickness defects can be reconstructed using simple or composite grafts. Full-thickness defects involving up to 30% of the upper lid are repaired easily by direct suturing with or without upper lid sliding flaps. When defects affect more than 50-70% of the upper lid, complex reconstruction is needed. Traditionally, this devolves upon lower lid flaps, as in the Cutler-Beard and Mustardé techniques. These methods share intrinsic disadvantages, such as donor site morbidity and the need for two surgical sessions to detach the flap pedicle. To our knowledge, upper lid reconstruction with a grafted forehead galeal-pericranial flap has not been previously reported. This proves to be an excellent reconstructive option for extensive upper lip defects. Moreover, it has many advantages over other reconstruction techniques, such as technical ease and very low donor site morbidity. Furthermore, it is a single-stage procedure. We present our experience with five extensive upper lid reconstructions using galeal-pericranial forehead grafted flaps.

Five patients needed major upper lid reconstruction, which consisted of a galeal-pericranial forehead flap grafted with oral mucosa and retroauricular skin. Four of them had had the lid removed surgically for oncological reasons, while one patient suffered from orbital-periorbital fasciitis.

All of the flaps and grafts survived. The functional and morphological results were satisfying, and no complications were noted.

The forehead galeal-pericranial flap appears to be an excellent instrument for upper lid reconstruction. Compared to other techniques, it has the advantages of simplicity and very minimal donor site morbidity. Moreover, it does not necessitate a two-stage surgical procedure.