ABSTRACT
To reconstruct eyelid defects involving greater degrees of tissue loss, a number of different surgical procedures have been devised. The choice depends on:
In deciding which procedure is most suited to the individual patient’s needs, one should aim to re-establish the following:
● A smooth mucosal surface to line the eyelid and protect the cornea
and mucosa originally provided by the tarsal plate ● A smooth, nonabrasive eyelid margin free from
keratin and trichiasis ● In the upper eyelid, normal vertical eyelid movement
without significant ptosis or lagophthalmos ● Normal horizontal tension with normal medial and
lateral canthal tendon positions ● Normal apposition of the eyelid and lacrimal
punctum to the globe ● A normal contour to the eyelid
Large eyelid defects generally require composite reconstruction in layers with a variety of tissues from either adjacent sources or from distant sites being used to replace both the anterior and posterior lamellae. It is essential that only one lamella should be reconstructed as a free graft. The
other lamella should be reconstructed as a vascularized flap to provide an adequate blood supply to prevent necrosis of the graft.
