Salvage of seeing eyes after avulsion of upper and lower lids

It is often stated that any injury severe enough to avulse both lids will inevitably destroy the globe. Two cases are presented in which the globe was uninjured but exposed, requiring immediate coverage. Local skin flaps placed over mobilized conjunctiva were used for emergency cover. One was eventually made into functioning eyelids; the other remains dormant. First-line options for local flaps may not be available because of regional trauma. The reconstructive surgeon caring for acute trauma patients should be familiar with all available options, including recently described island and myocutaneous flaps.