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The 'over-the-top' modified Cutler-Beard procedure for complete upper eyelid defect reconstruction
Saul N Rajak1,2, Raman Malhotra3, Dinesh Selva2
1a The Sussex Eye Hospital , Brighton and Sussex University Hospital , Brighton , UK.
Purpose:
To describe the 'Over-the-Top' Modified Cutler Beard Procedure (OTTMCB) for complete upper eyelid defect reconstruction Methods: This is retrospective case note review of four patients that underwent the OTTMCB procedure. This two-stage procedure comprises the replacement of the posterior lamella with a free tarsal graft from the contralateral upper eyelid, and the anterior lamella with a lower lid skin flap over the lower eyelid margin which is divided 2-4 weeks later.
Results:
The procedure was undertaken for four patients with 75-90% upper eyelid defects from tumour excision surgery. One patient had post-operative dehiscence requiring debridement and resuturing and further reconstructive surgery 18 months later to improve the cosmesis and lagophthalmos. The other three patients had good functional and cosmetic outcomes.
Conclusions:
The OTTMCB procedure replaces the anterior and posterior lamellae of the upper eyelid with 'like-for-like' tissues. It avoids some of the drawbacks of the original and other variations of the Cutler-Beard procedure and achieves a good cosmetic outcome.