Surgical management and reconstruction techniques for divided eyelid nevus: a systematic review

Divided eyelid nevus represents a congenital melanocytic lesion that carries malignant transformation potential and may compromise both aesthetic appearance and functional integrity of the eyelids. This systematic review examines surgical techniques for the complete excision and subsequent reconstruction of such lesions.

A systematic search was conducted across multiple databases including Web of Science, PubMed, Scopus, ProQuest, Science Direct, Cochrane Library, and Google Scholar, with the search extending until July 7, 2025. The main question of the study was: "What are the outcomes of reconstructive surgery for divided nevus?". No restrictions were applied regarding publication language, geographic location, or time period. Inclusion criteria consisted of original research studies evaluating surgical management of nevi, with particular focus on treatment efficacy and postoperative outcomes. Excluded studies comprised non-original research, qualitative studies, editorials, letters to the editor, and review articles. The methodology followed the PRISMA 2020 guidelines for systematic reviews.

The systematic review ultimately incorporated 33 studies evaluating various therapeutic modalities for nevus management, including surgical excision with primary closure, flap reconstruction techniques, skin grafting procedures, laser ablation, and cryotherapy. All surgical modalities demonstrated improvements in both aesthetic and functional outcomes; however, flap-based reconstruction yielded superior results compared to skin grafting, attributable to enhanced vascular perfusion. Common complications across techniques included madarosis, trichiasis, recurrence, and residual nevus cells.

Flap-based reconstruction consistently demonstrates superior functional and aesthetic outcomes compared to skin grafting, primarily due to enhanced vascularity and tissue compatibility. Other techniques have their own benefits and risks.