Tarsoconjunctival flap supplementation: an approach to the reconstruction of large lower eyelid defects

In the presence of a full-thickness lower eyelid defect too large for reconstruction with a tarsoconjunctival flap alone, the posterior lamella is often reconstructed with a free graft of nasal septal cartilage and mucosa, ear cartilage, or hard palate mucosa. In this series, an alternative approach was taken: a tarsoconjunctival flap of maximum horizontal dimension was created to reconstruct the majority of the posterior lamella defect. A second reconstruction technique, such as a periosteal flap or a Tenzel semicircular flap, was then used to supplement the tarsoconjunctival flap and reconstruct the remainder of the posterior lamella defect. Tarsoconjunctival flap supplementation yielded favorable results in eight patients and is advocated for the reconstruction of large posterior lamella defects too large for reconstruction with a tarsoconjunctival flap alone.