Single-stage frontalis muscle flap for full-thickness reconstruction of the upper eyelid

Full-thickness upper eyelid defects present a reconstructive challenge. Defects greater than 50% of the upper eyelid have traditionally been reconstructed with bulky full-thickness forehead flaps, Cutler-Beard flaps, Mustarde eyelid switches, and cheek rotation advancements, all mandating a second-stage surgical procedure. We propose a novel technique for full-thickness upper eyelid reconstruction based on a frontalis muscle flap elevated from the resection defect, thus resulting in no additional forehead scar.

Our patient is a 48-year-old woman with an enlarging right upper eyelid sebaceous cell carcinoma. A subsequent single-stage resection resulted in a medial full-thickness defect of 75% of the upper eyelid. The lateral and medial canthi were preserved. A palatal mucoperiosteal graft was harvested for the reconstruction of the posterior lamella. Dissection was carried through the excision defect in a preseptal plane over the supraorbital rim and subcutaneously over the frontalis muscle. A caudally pedicled frontalis muscle flap was elevated and inset to the defect edges with mild tension. Reconstruction of the skin defect of the upper eyelid was completed with a full-thickness preauricular skin graft.

The patient had no complications and demonstrated good function and aesthetic result at 15 weeks and at 9 months postoperatively.

Frontalis muscle flap-based reconstruction offers a viable option for upper eyelid defects that are full thickness and encompass more than 50% of the eyelid. We obtained a functionally and aesthetically pleasing outcome with this single-stage procedure using a preexisting incision with minimal donor-site morbidity.