Reconstruction of Large Full-Thickness Medial Lower Eyelid Defects Using a Medially Based Tarsoconjunctival Pedicle Flap

Summary: Reconstruction of large full-thickness medial lower eyelid margin defects often requires centrally based tarsoconjunctival pedicle flaps from the ipsilateral upper eyelid in combination with anterior lamellar grafting. However, centrally based flaps may result in temporary obstruction of the visual axis in the affected eye. The authors present a novel modified surgical technique using a medially based tarsoconjunctival pedicle flap from the upper eyelid for the reconstruction of large full-thickness medial lower eyelid defects. A tarsoconjunctival flap was mobilized and hinged medially by the conjunctiva from the upper eyelid with rotation into the lower eyelid defect. This surgical technique was used in 4 cases of medial lower eyelid defects involving 60% to 65% of the eyelid after basal cell carcinoma excision. Successful reconstruction of the defect was achieved in all 4 cases without graft failure, wound dehiscence, or lagophthalmos. Medially hinged tarsoconjunctival pedicle flaps are an effective technique for the reconstruction of large full-thickness medial lower eyelid defects. This procedure may be considered especially in patients with similar defects who cannot tolerate ocular occlusion.