Eyelid Reconstruction After Mohs Micrographic Surgery

Abstract

The eyelid consists of the anterior and the posterior lamellae. During reconstruction, both must be repaired to achieve optimal eyelid function, globe protection, and cosmesis. The method of reconstruction depends on the depth and thickness of the defect, state of the eyelid margin, and overall size of the wound. Regardless of which method is chosen, a key principle remains: there must be an inherent blood supply for either the anterior or the posterior lamella (pedicle flap). An inherent vascular supply ensures tissue survival and optimizes the functional and cosmetic outcomes. Additional principles of reconstruction include provision of maximal horizontal stabilization and minimization of vertical tension. There must be proper fixation of the eyelid at the lateral canthal angle, and the globe must face an epithelialized eyelid surface. Finally, in the upper eyelid, the levator must be identified and necessary repairs addressed during reconstruction to ensure proper opening and function.