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D. Paridaens, W.A. Van den Bosch; Orbicularis Muscle Flap Vascularising Free Posterior And Anterior Lamellar Graft: A One–Stage ‘Sandwich’ Technique For Eyelid Reconstruction . Invest. Ophthalmol. Vis. Sci. 2006;47(13):4711.
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© ARVO (1962-2015); The Authors (2016-present)
To report the efficacy of a one–stage technique for eyelid reconstruction, in which a vascularised orbicularis muscle flap is advanced between free anterior and posterior lamellar grafts.
a consecutive series of 13 patients was treated with this technique after radical excision of a malignant eyelid tumor. Full–thickness defects with a height of 5 mm up to 15 mm and a width of 10 mm up to 24 mm of the lower eyelid were reconstructed with a free tarsoconjunctival graft from the upper lid, an orbicularis muscle flap from the lower lid and a free skin graft from the upper lid. A subjective scoring system with 4 subsequent grades (poor, adequate, good, excellent) was used to assess the functional and cosmetic outcome.
After five days of patching, adequate viability of the grafts was noted in 11 of 13 patients. In two patients there was partial necrosis after postoperative hematoma. Complications included ectropion/lid retraction (3/13), granuloma (2/13) and notching (1/13). Two patients underwent additional block excision. At six months, the outcome was ‘poor’ in 0 cases, ‘adequate’ in 2 cases, ‘good’ in 6 cases and ‘excellent’ in 5 cases.
An orbicularis muscle flap advanced between free anterior and posterior lamellar grafts may provide adequate vascularization. This "sandwich" technique allows for one–stage reconstruction in vertically shallow (5–10 mm) to intermediate (10–15 mm) defects with a horizontal extent of <70% of the eyelid.
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