The arrowhead skin-muscle flap in the closure of lower eyelid defects

Lower-lid defects can arise from many sources, but they are often the result of excision of lower-lid tumors. The excision of the lesion is often performed by means of a pentagonal wedge resection. After repair of the tarsus and reapproximation of the lid margin, the skin and orbicularis are usually closed in a vertical fashion, which is perpendicular to relaxed skin tension lines and may extend further down the lid than is optimal as a result of a dog-ear excision. The authors propose a new method for closure of skin and orbicularis muscle in repair of lower eyelid marginal defects. This method is simple and has several advantages over vertical closure: it follows relaxed skin tension lines, allows closure of the anterior lamella in the opposite direction from the posterior lamella, and leaves an infraciliary scar rather than a vertical scar extending down the cheek. This method has been used in over 100 patients during the past 8 years, and no significant complications have occurred. Potential disadvantages of the technique include increased vertical tension and a tendency for the lid to be pulled downward. For these reasons, the arrow-head flap would not be the best choice in patients with preexisting lower eyelid retraction, cicatricial ectropion, or vertically tight lower-lid skin.