Full-thickness bipedicle flap for total lower eyelid reconstruction

Area of Science:

• Ophthalmology
• Plastic Surgery
• Reconstructive Surgery

Background:

• Total lower eyelid reconstruction presents challenges in achieving optimal functional and aesthetic outcomes.
• Existing methods often involve multiple stages, grafts, or substitutes, leading to potential complications and delayed rehabilitation.

Purpose of the Study:

• To describe and evaluate a novel technique for total lower eyelid reconstruction using a full-thickness bipedicle flap from the upper eyelid.
• To highlight the advantages of this technique over conventional methods.

Main Methods:

• A full-thickness bipedicle flap is harvested from the upper eyelid for lower eyelid reconstruction.
• Levator aponeurosis and Müller's muscle are recessed to prevent upper eyelid retraction.
• Meticulous surgical technique is employed to preserve microvascular blood supply and eyelid anatomy.

Main Results:

• The technique provides excellent tissue match and cosmesis in a single stage, avoiding distal flaps and grafts.
• It maintains the open palpebral fissure, facilitating rapid rehabilitation.
• The method effectively utilizes tarsus and orbicularis muscle, supports the eyelid, and reduces retraction, laxity, and ectropion.
• Fourteen cases demonstrated successful reconstructions with minor canthal deformities as the most common, easily correctable complication.

Conclusions:

• The described bipedicle flap technique is a viable and advantageous alternative for total lower eyelid reconstruction.
• It offers superior functional and aesthetic results with a streamlined surgical approach.
• This method should be considered in the reconstructive armamentarium for lower eyelid defects.