Bilobed flap in the reconstruction of inferior and/or lateral periorbital defects

To report the outcome of bilobed flap (BF) reconstruction of inferior and/or lateral periorbital defects following tumor excision.

Records of 20 patients who underwent inferior and/or lateral periorbital reconstruction with the BF were reviewed. The surgery was performed with local anesthesia in 18 patients and with general anesthesia in 2. Malignant tumors were excised together with a 4- to 5-mm margin of surrounding skin. Superolaterally based BFs were created from the malar or zygomatic region to cover the defects.

Patients ranged in age from 48 to 86 years (mean, 67 years). Nineteen patients had epithelial carcinoma and 1 had pilomatrixoma. Mean tumor diameter was 16 mm (range, 7-42 mm). Skin defects were located in the inferior (n = 14), lateral (n = 4), or inferolateral (n = 2) periorbital region. The BF was used in combination with the posterior lamella and/or canthus reconstruction techniques in 9 patients. For skin defects, BF was used alone in 17 patients, together with other flaps in 3. Primary closure of the skin defect with the flaps was achieved in 19 patients (95%). Three patients (15%) developed major complications requiring revision surgery (2 canthal webbings, 1 permanent pin-cushion deformity, and 1 ptosis) and 6 patients developed minor temporary complications. Mean follow-up duration was 34 months (range, 9-75 months).

The BF is a valuable alternative for reconstruction of inferior and/or lateral periorbital defects alone or in combination with other eyelid reconstruction methods to achieve good functional and aesthetic outcome.