Upper eyelid reconstruction using an advancement tarso-conjunctival flap

Area of Science:

• Ophthalmology
• Plastic Surgery
• Oncology

Background:

• Upper eyelid reconstruction presents functional and aesthetic challenges.
• Periocular malignancies often require complex surgical excision, such as Mohs Micrographic Surgery.
• Reconstruction of the posterior lamellae is critical for eyelid integrity.

Purpose of the Study:

• To evaluate the outcomes and complications of upper eyelid posterior lamellae reconstruction using an advancing tarso-conjunctival flap.
• To assess the efficacy of this technique following Mohs Micrographic Surgery for periocular malignancy.

Main Methods:

• Retrospective review of eight patients undergoing the procedure between May 2016 and January 2021.
• Data collected included patient demographics, defect characteristics, and post-operative outcomes.
• Factors influencing outcomes such as smoking and medication use were recorded.

Main Results:

• Minor complications included eyelid notch and retraction; one patient experienced lagophthalmos without exposure keratopathy.
• Two patients developed misdirected lashes, and two monocular patients had wound dehiscence.
• No vision loss or need for surgical revision occurred; follow-up ranged from 4-52 months.

Conclusions:

• Advancing tarso-conjunctival flap is a valuable single-stage technique for reconstructing up to two-thirds of the posterior lamellae in full-thickness upper eyelid defects.
• Complications are generally minor, making it suitable for patients where visual axis occlusion is unacceptable.
• This method is an effective component of reconstructive algorithms for periocular defects.