[Repair of full-thickness lower eyelid defect following surgical excision of malignant tumor using Hughes technique]

To evaluate surgical outcome of reconstruction of full-thickness lower eyelid defect resulting from tumor excision.

A retrospective case series review of patients with lower eyelid malignant tumor who underwent surgical repair of full-thickness eyelid defect from June 2008 to May 2013 was made. The defect ranged from 50% to 80% of the lower eyelid after excision of tumor with frozen section control of the surgical margins. Hughes technique was used to reconstruct the posterior lamellar and local flap and free graft were fashioned to repair the anterior defect. The pedicle was divided at 1-3 months postoperatively.

Of the 157 lower eyelid malignant tumors, the 3 most common types were basal cell carcinoma (107/157, 68.2%), sebaceous gland carcinoma (32/157, 20.4%), and malignant melanoma (10/157, 6.4%). Twenty-one eyelids of 21 patients (aged from 43 to 77 years old) were identified. No tumor recurred during follow-up period (8-60 months). There was only one case with squamous carcinoma metastasized to the parotid gland and then excised. The contour of all lower eyelids was satisfactory. No eyelid margin deformity or upper lid retraction was observed. Revision surgery was performed to treat lower lid entropion (3 patients), while mild lower lid retraction (2 patients) and temporary ectropion (one patient) required no management.

Hughes flap, which is a posterior lamellar replacement for lower eyelid defect after removal of malignant tumor, achieves favorable functional and cosmetic results.