Surgical Reconstruction of the Palpebral Border: Upper Lid Eyebrow???Musculocutaneous Island Flap

Author:
Publisher website
Google Scholar
Abstract
The palpebral border reconstruction constitutes a real challenge for plastic surgeons. The loss of palpebral tissues can be a consequence of congenital malformation, tumor resection, or traumatic injury. Not only the skin but also the tarsus, the conjunctival layer, and the eyelashes can be affected. The palpebral borders have an important function in ocular and corneal protection because of their tissue thickness and because the eyelashes act as a “hair barrier.” The aesthetic aspect is also very important because the anatomical discontinuity of the palpebral border produces an unaesthetic coloboma that cannot be camouflaged. Although many surgical techniques have been described for palpebral reconstruction, none of them achieves a reliable and specific reconstruction of the border according to aesthetic and functional considerations.1 Triangular border resection and end-to-end closure can be successful if the loss of palpebral border is less than one-third the length; however, when the tissue loss is more than one-third, it is necessary to use other surgical techniques. Usually, current flaps for lid reconstruction are also used for border repair. In the world medical literature, there is no description of a specific surgical technique for lid border reconstruction. In this article, a new surgical technique for palpebral border reconstruction is described using skin, orbicularis oculi muscle of the upper lid, and hairs of the eyebrow. This skill constitutes a modern indication of the upper lid musculocutaneous flap,2,3 permitting development of a hair-bearing island flap to repair different losses of upper and lower border lids. From 1988 through 2001, at the Plastic Surgery Department of Argerich Hospital, Buenos Aires, Argentina, 22 patients with loss of tissue in the border of the upper and lower lids underwent reconstruction using an upper lid musculocutaneous island flap. Six were male patients and 16 were female patients, with an average age of 28 years. The main causes were resection of malignant tumors in 14 patients (64 percent), congenital coloboma in four patients (18 percent), traumatic injury in three patients (14 percent), and necrosis postinfection in one patient (4.5 percent). Squamous cell carcinoma was found in four of the 14 patients (29 percent), basal cell carcinoma in nine patients (64 percent), and adnexal carcinoma in one patient (7 percent). In all patients, only one lateral pedicle was used; island flaps were basically composed of skin, subcutaneous fat, and orbicularis oculi muscle. In 20 patients (91 percent), the lowest lines of the hair eyebrow were included in the island flaps; in the other two cases, they were not. In 16 patients (73 percent), the reconstruction was performed in the border of the upper lid; in the other six (27 percent), in the lower lid. In all 22 patients, the conjunctival reconstruction was performed with undermining of the palpebral conjunctiva. A 45-year-old woman presented with a pigmented squamous cell carcinoma in the middle of the border of the upper lid (Fig. 1). Surgical tumor resection left a wide palpebral and border defect measuring 1.3 cm × 6 mm, including the eyelashes. A lateral pedicled upper lid musculocutaneous flap including hairs of the eyebrow was raised and sutured into the defect; the conjunctival layer was reconstructed by fornix undermining (Fig. 2). One year after the operation, an excellent aesthetic and functional result was obtained (Fig. 3).

This publication has 3 references indexed in Scilit: