Tarsal-Conjunctival Advancement Flap in Lower Eyelid Reconstruction

  • Viraj J. Mehta
  • Rachel K. SobelEmail author


The tarsal-conjunctival flap is a versatile technique with many advantages for repairing large lower eyelid defects. It is fairly straightforward from a technical standpoint and takes less operative time than major flaps and free grafts. Since its introduction in the early twentieth century, several modifications have improved upon the major complications, including upper lid retraction, upper lid entropion, and eyelid margin erythema. This chapter discusses the main principles of eyelid reconstruction, the algorithm for repairing lower eyelid defects, and the step-by-step manual for performing the tarsal-conjunctival flap.


Hughes flap Tarsal-conjunctival flap Full-thickness eyelid defect Eyelid reconstruction 

Supplementary material

419986_5_En_37_MOESM1_ESM.mp4 (236.5 mb)
Video 37.1 Hughes flap (tarsal-conjunctival flap). Courtesy of Richard C. Allen, MD, PhD, FACS. (MP4 242223 kb)
419986_5_En_37_MOESM2_ESM.mp4 (189.3 mb)
Video 37.2 Hughes flap with skin graft. Courtesy of Richard C. Allen, MD, PhD, FACS. (MP4 193850 kb)
419986_5_En_37_MOESM3_ESM.mp4 (75.3 mb)
Video 37.3 Second stage Hughes flap. Courtesy of Richard C. Allen, MD, PhD, FACS. (MP4 77100 kb)


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of OphthalmologyMayo ClinicRochesterUSA
  2. 2.Department of OphthalmologyVanderbilt University Medical CenterNashvilleUSA

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