Myotarsal flap - a versatile entity for lower eyelid reconstructions

The purpose is to present a new surgical technique using myotarsal (MT) flap for reconstruction of small to subtotal full thickness defects - up to 8 mm in height - of lower eyelids, without needing concomitant supplementary procedures. MT flap consists of a 3 mm tarsal strip with attached levator complex. It does not have conjunctival lining or pedicle. Versatility of the flap extends to correction of mild to severe ptosis, and retraction of upper eyelids. This is a retrospective personal series of 163 patients, who underwent surgical reconstruction with MT flap overlaid with quilted skin graft (modified myotarsal flap) after excision of malignant tumours of lower eyelid. Surgery was on day case basis under LA. Patients were assessed for aesthetic and functional outcome, and complications. No patient had any complication. Assessment of outcome included corneal and ocular surface health and protection, eye closure, tear secretion, and lid contours. These were aesthetically and functionally satisfactory. Histology confirmed complete tumour clearance, and clinical diagnosis. There was no recurrence of tumour. An astounding, new, unique and original observation of the study is that cornea and ocular surface remained undamaged throughout, despite absence of conjunctival lining of MT flap. This goes against all current tenets of oculoplasty. Use of the modified MT flap is a safe, versatile, and effective procedure yielding satisfactory aesthetic and functional results for reconstruction of the lower eyelid.