Tarsoconjunctival Rotational Flap in Second-stage Modified Hughes Reconstruction for Lower Eyelid Full-thickness...

Unrefined eyelid margin is a known complication following the second-stage modified Hughes eyelid reconstruction. Lateral canthal malposition, phimosis, or eyelid laxity can occur when the tarsoconjunctival flap extends to cover the defects in the inferior crus of the lateral canthus. This study presents a novel surgical technique that prevents lower eyelid margin distortions, lower eyelid laxity, and lateral canthal complications after the second-stage modified Hughes reconstruction.

A retrospective review of patients who underwent second-stage modified Hughes reconstructions with a lateralized tarsoconjunctival rotational flap from July 2021 to August 2024 was performed. The study outcomes included postreconstruction complications, such as eyelid malposition, eyelid margin changes, lateral canthus distortions, flap dehiscence, and eyelid-related complaints. Postoperative photographs were reviewed to evaluate eyelid position, flap, and lateral canthus contour.

Nineteen patients underwent repair using a tarsoconjunctival rotational flap as part of the second-stage modified Hughes reconstruction. The average time between the first and second-stage modified Hughes reconstruction was 61.5 ± 10.6 days. Postoperative photos showed no cases of hyperemic eyelid margins, hypertrophic eyelid margins, inferior canthal tendon laxity, lateral canthus phimosis, lateral canthus imbrications, flap dehiscence, or lateral canthal irritations. One patient complained of persistent lower eyelid irritation and discharge, and 1 patient had persistent edema, both of which resolved at the last follow-up.

The lateralized tarsoconjunctival rotational flap has favorable surgical outcomes in the second-stage modified Hughes reconstruction of lower eyelid defects.