The Use of Composite Flaps in the Management of Large Full-Thickness Defects of the Lower Eyelid

To describe a modified surgical procedure that uses a combination of the tarsoconjunctival flap, orbicularis myocutaneous advancement flap, and paranasal-island flap to correct extensive full-thickness lower eyelid defects in functioning eyes. From May 2010 to December 2013, a total of 15 patients had reconstructive surgeries of large to giant lower eyelid defect, with an average 19-month follow-up. The musculocutaneous flaps were harvested from both orbicularis and paranasal regions and clinical outcomes were recorded and analyzed. No major complications were observed in any of the patients. All the patients showed aesthetic eyelid contour, good color, and texture match as well as no obvious scar formation. The mean Marginal Reflex Distance-2 measured 4 months after surgery was 4.9 ± 0.4 mm. Reconstruction of a large defect in the lower eyelid with a tarsoconjunctival flap and the composite neighboring musculocutaneous flaps is a reliable and reproducible method. With proper design and well-executed precision, excellent functional and aesthetic results can be achieved by this elegant procedure without any major complications.