Myotarsal flap - a versatile entity for lower eyelid reconstructions.

Area of Science:

• Ophthalmology
• Plastic Surgery
• Oncology

Background:

• Reconstruction of full-thickness lower eyelid defects often requires complex procedures.
• Existing techniques may involve supplementary procedures or have limitations in versatility.
• The myotarsal (MT) flap presents a potential alternative for eyelid reconstruction.

Purpose of the Study:

• To present a new surgical technique using the myotarsal (MT) flap for reconstructing small to subtotal full-thickness lower eyelid defects (up to 8 mm).
• To evaluate the safety, versatility, and efficacy of the modified MT flap in patients undergoing lower eyelid tumor excision.
• To assess aesthetic and functional outcomes, including ocular surface health, following reconstruction with the modified MT flap.

Main Methods:

• A retrospective series of 163 patients undergoing lower eyelid reconstruction with a modified MT flap (MT flap with quilted skin graft) after malignant tumor excision.
• Surgical procedures were performed on a day-case basis under local anesthesia (LA).
• Outcomes assessed included aesthetic and functional results, complications, corneal and ocular surface health, eye closure, tear secretion, and lid contours.

Main Results:

• The modified MT flap procedure resulted in satisfactory aesthetic and functional outcomes with no reported complications in 163 patients.
• Histology confirmed complete tumor clearance and no tumor recurrence.
• A key finding was the preservation of corneal and ocular surface health despite the flap lacking conjunctival lining, challenging current oculoplastic tenets.

Conclusions:

• The modified myotarsal (MT) flap is a safe, versatile, and effective technique for lower eyelid reconstruction, yielding satisfactory aesthetic and functional results.
• This technique offers a unique solution for full-thickness lower eyelid defects, even without conjunctival lining, maintaining ocular surface integrity.
• The MT flap demonstrates significant potential for various eyelid reconstructive challenges, including ptosis and retraction correction.