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Lower eyelid margin reconstruction: results of five different techniques
Philip L Custer1, Robi N Maamari1, Tiffany C Ho1
1John F. Hardesty MD, Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri, USA.
Orbit (Amsterdam, Netherlands)
|July 27, 2022
Summary
Semicircular and sliding tarsal flaps offer effective lower eyelid reconstruction after Mohs surgery, balancing cosmetic and functional outcomes. Tarsoconjunctival flaps require more interventions and cause deformities, while semicircular flaps preserve the lash line but risk lateral canthal issues.
Area of Science:
- Ophthalmology
- Plastic Surgery
- Dermatology
Background:
- Mohs surgery offers high cure rates for skin cancer but often requires complex reconstruction.
- Lower eyelid defects present unique challenges for functional and aesthetic restoration.
- Various surgical techniques exist for lower eyelid margin reconstruction, each with potential benefits and drawbacks.
Purpose of the Study:
- To compare the surgical outcomes of five distinct techniques for lower eyelid margin reconstruction following Mohs surgery.
- To evaluate functional and cosmetic results, complication rates, and need for secondary interventions across different reconstruction methods.
Main Methods:
- Retrospective review of 178 patients undergoing lower eyelid reconstruction between 2005 and 2020.
- Surgical techniques analyzed: primary closure, semicircular flap, dermal matrix graft, sliding tarsal flap, and tarsoconjunctival flap.
- Outcomes assessed via masked photographic review by oculoplastic surgeons, evaluating both masked and unmasked defect information.
Main Results:
- All patients achieved good-excellent functional results; 90.4% were asymptomatic.
- Tarsoconjunctival flaps showed higher rates of revision surgery and anterior lamellar deformities (p<.001).
- Semicircular flaps preserved the lash line but increased lateral canthal deformity risk (p<.001); sliding tarsal flaps were effective for shallow defects.
Conclusions:
- Semicircular and sliding tarsal flaps provide favorable functional and cosmetic outcomes for lower eyelid reconstruction.
- Tarsoconjunctival flaps are associated with a higher need for subsequent interventions and deformities.
- Dermal matrix grafts offer comparable results to tarsoconjunctival flaps in single-stage reconstruction.
