The Use of Tarsomarginal Graft in Full-Thickness Inferior Lid Reconstruction After Tumor Resection

Inferior lid reconstruction following tumor resection represents a challenge in consideration of the complex anatomy of this anatomic region. The goal of eyelid reconstruction is functional and aesthetic restoration. In the cases presented in this study, patients presented a basocellular carcinoma of the lower lid. A full-thickness resection with wide margins (3 mm negative margins), involving the lid margin, was performed, and medial, lateral, and deep margins were subjected to extemporaneous histologic examination. The dimensions of the resulting defect were between 25% and 50% of the lower lid's total length. When a full-thickness resection of the inferior eyelid, including the lid margin, is performed, both the anterior and the posterior lamellae need to be reconstructed. The reconstruction needs considered were: posterior lamella reconstruction-need for support to avoid ectropion and lagophthalmos, a mucosal layer to reconstruct the conjunctival layer; anterior lamella reconstruction-a miocutaneous layer that matched the surrounding skin. Lash line reconstruction. With these goals in mind, the authors chose a tarsomarginal graft harvested from the contralateral side for the posterior lamella reconstruction and for the anterior lamella either a miocutaneous transposition flap, nasojugal for the medial defects, or a cheek flap for the lateral defects, or first-intention closure. These choices allow for a full restoration of function and aesthetics with minimal morbidity of the donor side. The choice of the tarsomarginal flap allowed not only support to the lower lid and conjunctival repair but also restoration of the grey line and the lashes.