Purchase this article with an account.
Clifton Blake Perry, Keith Carter, Richard Allen; Horizontal Tarsal Transposition Flap and Lateral Canthal Fixation for Repair of Large, Central Lower Eyelid Defects. Invest. Ophthalmol. Vis. Sci. 2013;54(15):6373.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To describe a procedure for repairing central and medial full thickness defects of the lower lid which involve 50 to 66% of the horizontal length of the eyelid. The procedure employees a horizontal tarsal transposition flap with lateral canthal fixation using a periosteal strip and/or a free tarsal graft to reconstruct the posterior lamella and a myocutaneous advancement flap to repair the anterior lamella defect.
This is a non-randomized, non-comparative, retrospective case study.
Eighteen patients underwent repair using the described technique. The average age was 69.2 years. Fourteen patients were female. All patients underwent Mohs excision of a skin cancer: 16 patients had a basal cell carcinoma and 2 patients had a squamous cell carcinoma. Six defects were on the right and 12 were on the left. Nine of the patients were judged to have 50% defect, while the remainder of the patients were judged to have a 66% defect. The average follow up was 4.4 months. Eight patients had post-operative sequelae that did not require further surgery: two patients had mild cicatricial ectropion, one patient had a pyogenic granuloma, one patient had a kink in the upper eyelid at the donor site for the free tarsal graft, one patient had a small area of symblepharon laterally, and one patient had early lower lid retraction which responded to a steroid injection.
We believe this is a useful procedure to employ in the repair of full thickness defects of the central and medial lower eyelid which involve 50% to 66% of the horizontal length of the eyelid. The procedure has the following advantages over a Hughes flap: the eye is not closed post-operatively; a second stage is not required; eyelashes are preserved medially; and the lid margin heals well without erythema. Although a critical review of the patients post-operatively shows that 44% of patients have some issue, none was judged significant enough by the patient or physician to require any further surgery.
This PDF is available to Subscribers Only