Treatment of Divided Eyelid Nevus using Single Split-Flaps: Clinical Experience and Systematic Review

Area of Science:

• Plastic Surgery
• Ophthalmology
• Congenital Nevi Management

Background:

• Divided eyelid nevus is a rare congenital condition presenting significant reconstructive challenges.
• This study evaluates the efficacy of single split-flap techniques for medium to large eyelid lesions.

Purpose of the Study:

• To assess the outcomes of single split-flaps using pre-expanded superficial temporal artery frontal branch (STA-Fbr)-based and distally based brachial artery perforator (dBAP) flaps.
• To compare the effectiveness of fish-mouth versus window flap splitting patterns.
• To evaluate the role of intraoperative indocyanine green angiography (ICGA) in guiding reconstruction.

Main Methods:

• Retrospective analysis of 26 patients treated between 2005 and 2024.
• Reconstruction utilized STA-Fbr flaps (n=11) or dBAP flaps (n=15).
• ICGA guided vessel mapping, flap splitting, and perfusion assessment; flaps were split in fish-mouth or window patterns.

Main Results:

• Successful reconstruction of 11 medium and 14 large lesions.
• ICGA accurately guided flap splitting and confirmed adequate perfusion.
• All flaps survived without complications; systematic review confirmed flap reliability for large lesions.

Conclusions:

• Single split-flap technique with pre-expanded STA-Fbr or dBAP flaps is reliable for simultaneous bilateral eyelid reconstruction.
• ICGA guidance enhances flap splitting and perfusion assessment.
• Favorable functional and aesthetic outcomes were achieved for medium and large divided eyelid nevus lesions.