"Lid Switch Flap" for Subtotal Upper Eyelid Reconstruction: Where the Flap Pedicle and the Point of Rotation Should...

We report our experience using the "lid switch flap" for the reconstruction of large upper eyelid defects, emphasizing on the design, the point of flap rotation, and the detailed description of the surgical technique. From 2018 to 2021, three patients with squamous cell carcinoma (SCC) invading 50 to 70% of the upper eyelid underwent tumor excision. The defects were reconstructed using the two-stage "lid switch flap" method. At the first stage, the "switch flap" from the lower eyelid was designed medially based preferably, elevated and "switched" to the defect, whereas the pedicle was divided at the second stage in 2 to 3 weeks. The mean of defect widths after tumor excision (D) was 23.6 mm (range: 18-29 mm) and the mean of widths of lid switch flaps (F) was 15.3 mm (range: 10-20 mm), and thus, the mean of F/D ratio was 0.63 (range: 0.55-0.69). The histopathology report confirmed the complete excision of the SCCs. The patients were followed up for 2 years. The functional and aesthetic results were excellent. Level of Evidence  Level II, therapeutic study.