A novel one-step repair of large lower eyelid defects following tumor resection in adults: surgical technique and outcome

Abstract

Background

Large full-thickness lower eyelid defects are repaired by “one- or two-step” flap-flap or flap-graft combinations. I present the long-term surgical outcome of a novel “one-step” closure of full-thickness lower eyelid defects by using two autografts for the reconstruction of the anterior and posterior lamellas following malignant tumor removal.

Methods

Non-comparative case series of lower eyelid reconstructions were performed by a single surgeon between 2003 and 2020. Horizontal and vertical lengths of eyelid defects were measured. The required autografts were chosen from the ipsi-contralateral upper eyelid. Surgical success was defined as the achievement of satisfactory lower eyelid anatomy with the best esthetic and functional outcomes without needing further interventions.

Results

Thirty-nine lower eyelids (21 right,18 left) of 39 patients (25 men, 14 women) with a mean age of 65.2 ± 8.1 years (53–85) had reconstructive surgery by this method after malignant tumor resection. Eyelid defects involved more than 50% of their horizontal lengths with a mean size of 18.3 ± 2.8 mm horizontally and 8.7 ± 2.3 mm vertically. The mean follow-up time was 36.5 ± 12.3 months (3–58). Functional and esthetic outcomes were excellent or good in all cases and no patient needed additional interventions in the repaired area or demonstrated graft rejection. Postoperative complications were graft edema (n = 15), ecchymosis (n = 9), eyelid margin thinning (n = 3), mild lagophthalmos (n = 1), eyelid contour irregularity (n = 1), retraction (n = 1), and granuloma formation (n = 1).

Conclusions

“One-step” reconstruction of large full-thickness lower eyelid defects using two autografts seems to be effective, simple, and practical for the repair of the anterior and posterior lid lamellas with good esthetic and functional long-term results.

Level of evidence: Level IV, therapeutic study.