Two Advancement Flaps for Eyelid Margin Reconstruction of Small and Medium Defects and a Novel Design to Reduce Ocular Injury

Abstract

Purpose

The key point of eyelid margin reconstruction is to keep both the support function and aesthetic appearance. The eyelid’s complex anatomical structures make eyelid margin reconstruction demanding. Eyelid margin defects are conventionally classified by their width relative to the eyelid width: small, medium, or large. In this study, we introduce a reconstruction method for small to medium defects.

Patients and Methods

We conducted a single-center case series of patients from the practice of a single experienced plastic surgeon at a tertiary center. We included consecutive outpatients from 2014 to 2021. The inclusion criteria were (1) eyelid margin mass and (2) willingness to receive eyelid margin reconstruction by the reported method. The exclusion criteria were (1) eyelid margin mass involving most or all of the tarsus and (2) less than one year of follow-up. Patients were followed up face to face or online. Patients’ demographics, clinical characteristics and outcomes, and satisfaction were collected. The clinical outcomes were assessed and scored by two plastic surgeons.

Procedure

We reconstructed the anterior lamella with an advancement musculocutaneous flap and repaired the posterior lamella with a specially designed advancement tarsoconjunctival flap, of which a piece of tarsus was shaved and the corresponding remnant conjunctiva was bent forward to cover the tarsus edge to avoid ocular injury.

Results

We included 24 patients (25 lesions). Almost all patients had eyelash discontinuity. One patient presented slight notching of the lower eyelid margin. The other patients reported no complications or recurrence. The average outcome score was 1.23±0.69, indicating that our method was excellent. All patients were very satisfied with the surgery. The average follow-up time was 5.75 years.

Conclusion

We report a reconstruction method for small to medium eyelid margin defects and a novel design for preventing ocular injury, which is an especially good option for transverse defects.

Keywords:

• eyelid margin
• reconstruction
• tarsoconjunctival flap
• advancement flap

Abbreviations

VSS, Vancouver Scar Scale.

Data Sharing Statement

The authors do not intend to share individual participant data because all necessary data have been reported in this paper.

Ethics Approval and Informed Consent

Our study was approved by the Medical Ethics Committee of the Second Affiliated Hospital of Harbin Medical University. The permit number is KY-2016005. Informed consent was obtained from all patients.

Consent for Publication

All patients in the figures have been shown the article contents and gave the consent. All figures are original and have not been published elsewhere previously.

Clinical Trials Registration

We have prospectively registered the trial in Chinese Clinical Trial Registry (ChiCTR) and the Clinical Trial Registration number is ChiCTR-ONC-16007886.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

All authors report no conflicts of interest or competing interests in this work.

Additional information

Funding

This work was supported by the young and middle aged innovative science research foundation of the second affiliated hospital of Harbin medical university (KYCX2018-05), the Heilongjiang provincial postdoctoral science foundation (0202-21042160137), the Heilongjiang province natural science foundation (LH2019H069), the Chinese postdoctoral science foundation (2019M661299).