Success of Myocutaneous Flaps Without Posterior Lamellar Reconstruction for Large Full-Thickness Eyelid Mohs Defects

For full-thickness Mohs eyelid defects, closure involves reconstruction of the posterior lamella (conjunctiva and tarsus) and anterior lamella (skin and orbicularis muscle).

This study examines the necessity of dedicated posterior lamellar reconstruction in the repair of large, full-thickness eyelid defects based on functional and histologic analysis of the posterior margin without dedicated reconstruction of the posterior mucosa.

A case series of consecutive large Mohs eyelid defects (>50% loss of palpebral conjunctiva) repaired with myocutaneous flaps without dedicated posterior mucosal reconstruction were reviewed. Postoperative complaints were recorded. Biopsies of the posterior eyelid were reviewed from 4 patients during scheduled 4- to 6-week secondary separation of interpolated flaps or debulking.

Twenty-six cases were identified, of which 16 (62%) lost >90% of the involved eyelid. A variety of flaps were employed (paramedian/glabellar, Fricke, nasolabial rotation, Mustarde) with good outcomes. Complications were uncommon and infrequent. All 4 biopsy specimens showed "squamous epithelium," "conjunctival epithelium," or "mucosa" without evidence of keratinization.

This series suggests that posterior mucosa reconstruction may not be necessary in cases of full-thickness eyelid defect repair as large myocutaneous flaps may act as a matrix for de novo regeneration, or extension, of conjunctival-like squamous epithelium on the posterior eyelid.