Lower Eyelid Reconstruction with Combined Sliding Tarsal and Rhomboid Skin Flaps

To report results in patients undergoing lower eyelid reconstruction following Mohs surgery using a combination of surgical techniques, the rhomboid skin flap and a sliding tarsal flap.

An IRB approved, retrospective case series of patients undergoing surgery between April 2007 and October 2014. Outcomes include establishment of a functional eyelid, quality of postoperative eyelid margin contour, and postoperative complications.

During the study period, sliding tarsal flaps were used to repair marginal lower eyelid defects in 32 patients. Coexisting anterior lamellar defects were repaired with a modified rhomboid skin flap in 24 patients, a full thickness skin graft in 4 patients, and combined skin graft and rhomboid flaps in 4 patients. The average width of the marginal defects was 11.3 mm (range: 7-19 mm). Reconstruction resulted in a functional lower eyelid in all patients, the majority having an excellent cosmetic result (n = 20). Minimal contour abnormalities were present in 9 patients, while 3 patients developed a noticeable notch following surgery. Patients repaired with a rhomboid flap were more likely to have isolated postoperative misdirected lashes (5/24) than those repaired using a skin graft with or without a flap (0/8).

Combined sliding tarsal and modified rhomboid skin flaps are an effective method of repairing superficial defects of the lower eyelid margin. This tissue-preserving technique maintains the ability to perform subsequent upper eyelid tarsoconjunctival flaps and lateral canthal procedures should a future need arise. Isolated misdirected lashes and minor contour abnormalities are the most common complications of the procedure.