Eye Comfort and Physiological Reconstruction of an Entire Upper Eyelid Defect

Yasuhiro Sakata, MD; Katsuya Okuda, MD, DDS, PhD; Yoshitaka Wada, MD, PhD; Shinji Kumegawa, MD; Hirohisa Kusuhara, MD, PhD; Noritaka Isogai, MD, PhD; Shinichi Asamura, MD, PhD

Disclosures

ePlasty. 2020;20(e5) 

In This Article

Abstract and Introduction

Abstract

Objective: Reconstruction of an extensive full-thickness upper eyelid defect is challenging. The purpose of this report is to introduce this procedure with emphasis on reconstruction of the eyelid margin to obtain eye comfort.

Methods: We designed a technique using a radial forearm flap for the outer layer to reconstruct the entire eyelid after resection of Merkel cell carcinoma. In additional, the inner layer and the eyelid margin were reconstructed with a buccal mucosal graft and a reverse Hughes flap. Results: There has been no recurrence of the tumor, opening and closing functions of the eyelid are maintained, and the patient has not complained of eye discomfort.

Conclusion: Maintenance of mobility, flexibility, and a good ocular surface in contact with the sensitive cornea are the main foci of upper eyelid reconstruction, with an optimal fissure height and an appropriate contour of the eyelid. In addition, to obtain eye comfort, it is important to protect the cornea without significantly restricting eyelid mobility.

Introduction

Reconstruction of the entire upper eyelid is a challenging procedure for plastic surgeons. Even if functional repair is perfect, patients may not be satisfied with the cosmetic results, or vice versa. Total reconstruction of the upper eyelid can be performed with lower eyelid tissue using the Cutler-Beard procedure or the Mustard method;[1–3] however, it is difficult to reconstruct wide defects that extend beyond the medial or lateral canthus using these methods. In the case reported here, total upper eyelid reconstruction was performed using a radial forearm flap for the outer layer and a buccal mucosal graft and a reverse Hughes flap for the inner layer,[4] which contains the eyelid margin. The purpose of this report is to introduce this procedure with an emphasis on reconstruction of the eyelid margin to obtain eye comfort.

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