Single-stage repair of large full thickness lower eyelid defects using free tarsoconjunctival graft and transposition flap: experience and outcomes

Abstract

Background: Lid-sharing approaches are often advocated for repair of large full thickness lower eyelid defects, however result in temporary visual obstruction and the need for a second-stage procedure. The authors describe and report outcomes using a one-stage technique utilizing a free tarsoconjunctival graft (TCG) and musculocutaneous transposition flap (MCT) to repair defects up to 90% of the lower eyelid. Methods: A retrospective chart review on patients that had undergone full thickness lower eyelid reconstruction using a TCG and MCT between the dates of 1/1/2015 to 3/1/2020 was performed. Demographic and clinical information including indication for repair, size of defect, post-operative complications, and outcomes were recorded and analyzed. Results: Six cases of lower eyelid reconstruction using this technique were identified. Fifty percent were male, average age was 61.3 years (range 36–91, SD = 18.9), and follow up was 36.7 weeks (range 3–129, SD = 48.1). All defects were due to malignancy (4/6 for basal cell carcinoma, 1/6 each for sebaceous cell carcinoma and merkel cell carcinoma). Average horizontal defect size was 80% of lower eyelid width (range 57%-90%, SD = 12.3), while average vertical defect size was 8 mm (range 5–10 mm, SD = 1.7). There were no instances of post-operative infection, lid malposition, or dehiscence. A pyogenic granuloma was noted in one case and was managed with excision. Conclusion: A single-stage procedure using a TCG and MCT can be used to repair laterally based full-thickness lower eyelid defects up to 90% with satisfactory outcomes and few complications.