Lower lid reconstruction using tarsoconjunctival grafts and bipedicle skin-muscle flap

We describe a method of subtotal lower eyelid reconstruction employing either a free tarsoconjunctival graft or a transpositional tarsoconjunctival flap from the upper lid together with a bipedicle skin-muscle advancement flap from the lower lid. A full-thickness skin graft is placed into the defect created by the movement of the bipedicle flap. This technique obviates the need to use a lid-sharing procedure that occludes the fissure and would be indicated for the monocular patient or one who would be at a serious disadvantage with the eye covered for several weeks.