This is a retrospective review of a lower lid reconstructive technique utilising a sliding tarsal flap. Thirty-two patients who had undergone Mohs surgery were included and each had a shallow marginal defect with at least one remaining tarsal edge having a sloping contour from the lid margin to the inferior aspect of the defect. Defect widths ranged from 7-19mm. If there was sufficient lid laxity, the lid margin was reconstructed using an oblique incision passing from the base of the defect under this sloping tarsal remnant towards the inferior fornix. This mobilised tissue was then slid sideways and upwards over the opposite tarsal remnant to recreate the posterior lid margin. The redundant conjunctiva and retractors in the inferior fornix created by this action was excised and closed, and the tarsal plate edges then sutured together. The anterior lamellar defect was then reconstructed with a rhomboid flap, a full-thickness skin graft or a combination of the two. Twenty of the 32 patients had an excellent cosmetic result, and nine had mild contour abnormalities. Three had significant notches or irregularities. Five patients had misdirected lashes, but none required further surgical intervention. This is a useful technique for shallow lower lid defects which avoids the use of a free tarsal graft or a tarso-conjunctival flap from the upper lid. However it is a more complex procedure than direct closure, with or without a lateral canthotomy, which may have been used to close some of the smaller defects.

Lower eyelid reconstruction with combined sliding tarsal and rhomboid skin flaps.
Custer PL, Neimkin M.
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James Hsuan

Aintree University Hospital, Liverpool, UK.

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