The final esthetic result is a common concern of patients with eyelid tumors, especially young patients and those with tumors affecting the medial edge of the lower eyelid.
The procedure herein described combines two lateral flaps: one tarsoconjunctival and the other from the periosteum. The first step is removal of the tumor lesion. Preseptal dissection is then performed through a subciliary incision on both the lateral and medial halves of the eyelid up to the orbital rim. Next, the lateral canthal tendon, lateral attachment of the orbital septum, capsulopalpebral fascia, and conjunctiva are cut. This allows the medial displacement of the tarsoconjunctival flap, which is sutured to the defect area. The second flap, a periosteal strip, is used to reconstruct the tarsus and lateral canthal tendon, providing firm support for the posterior lamella. The orbicularis muscle is anchored to the orbital rim, and the skin of the lower eyelid is directly sutured to the subciliary incision and periosteal strip.
The author successfully carried out this procedure on nine patients. None of the patients developed ocular irritation or postoperative epiphora.
The defects that can be repaired by this technique are equivalent in size to those repaired by the Tenzel procedure. Unlike the semicircular flap procedure, this technique allows eyelid reconstruction with no vertical scarring and a smaller lateral incision, and it ensures soft contact between the palpebral rim and surface of the eyeball. This procedure confers an attractive eyelid appearance that may be crucial for some patients.
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Tenzel RR (1975) Reconstruction of the central one half of an eyelid. Arch Ophthalmol 93:125–126
Fogagnolo P, Colletti G, Valassina D, Allevi F, Rossetti L (2012) Partial and total lower lid reconstruction: our experience with 41 cases. Ophthalmologica 228:239–243
Tenzel RR, Stewart WB (1978) Eyelid reconstruction by the semicircle flap technique. Ophthalmology 85:1164–1169
Stephenson C (1983) Reconstruction of the eyelid using a myocutaneous island flap. Ophthalmology 90:1060–1065
Glatt HJ (1997) Tarsoconjunctival flap supplementation: an approach to the reconstruction of large lower eyelid defects. Ophthal Plast Reconstr Surg 13:90–97
Lemke BN, Sires BS, Dortzbach RK (1999) A tarsal strip-periosteal flap technique for lateral canthal fixation. Ophthalmic Surg Lasers 30:232–236
Game J, Morlet N (2007) Lateral canthal fixation using an oblique vertically orientated asymmetric periosteal transposition flap. Clin Experiment Ophthalmol 35:204–207
Meena M (2012) Triple-Flaps for lateral canthus reconstruction: a novel technique. Oman J Ophthalmol 5:181–183
Porfiris E, Kalokerinos D, Christopoulos A, Damilakos P, Ioannidis A, Georgiou P (2000) Upper eyelid island orbicularis oculi myocutaneous flap for periorbital reconstruction. Ophthal Plast Reconstr Surg 16:42–44
Garces JR, Guedes A, Alegre M, Alomar A (2009) Double mucosal and myocutaneous island flap: a one-stage reconstruction for full-thickness lower eyelid defect. Dermatol Surg 35:779–785
Miller EA, Boynton JR (1987) Complications of eyelid reconstruction using a semicircular flap. Ophthalmic Surg 18:807–810
Fuertes-Lanzuela S (1988) Aesthetic total lower eyelid reconstruction. Aesthetic Plast Surg 12:159–163
Lim SA, Ryu AY, Lee DL, Yoon YI (2012) Treatment of congenital divided nevus of the eyelid with excision and blepharoplasty. Arch Plast Surg 39:437–439
Irvine F, McNab AA (2003) A technique for reconstruction of upper lid marginal defects. Br J Ophthalmol 87:279–281
Moesen I, Paridaens D (2007) A technique for the reconstruction of lower eyelid marginal defects. Br J Ophthalmol 91:1695–1697
Ito O, Suzuki S, Park S, Kawazoe T, Sato M, Saso Y, Iwasaki Y, Hata Y (2001) Eyelid reconstruction using a hard palate mucoperiosteal graft combined with a V–Y subcutaneously pedicled flap. Br J Plast Surg 54:106–111
Zinkernagel MS, Catalano E, Ammann-Rauch D (2007) Free tarsal graft combined with skin transposition flap for full-thickness lower eyelid reconstruction. Ophthal Plast Reconstr Surg 23:228–231
Conflict of interest
The author declares that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Toribio, J.Á. Double Lateral Flap: A New Technique for Lower Eyelid Reconstruction Alternative to the Tenzel Procedure. Aesth Plast Surg 39, 935–941 (2015). https://doi.org/10.1007/s00266-015-0576-7
- Lower eyelid defect
- Eyelid tumors
- Tarsoconjunctival flap
- Periosteal strip
- Semicircular flap procedure