Laterally Based Tarsoconjunctival Transposition Flap to The Lower Eyelid

C. BEARD

J. H. SULLIVAN

In this method of up to total lower eyelid reconstruction, the tarsoconjunctiva and skin are obtained from separate, rather than contiguous, areas (1, 2). The procedure was developed to be used in place of the popular Hughes operation (3), the latter requiring occlusion of the eye for several weeks (see Chapter 15). This visual deprivation was troublesome to many patients, particularly those with less than good vision in the unoperated eye.

INDICATIONS

This operation can be used for almost any lower lid reconstruction when the defect is too large for direct closure. Since it is based laterally, this flap is ideally suited for defects that extend to the lateral canthus. If the most lateral portion of the lower lid is intact, it must either be transferred to the nasal side of the defect as a full-thickness, inferiorly based pedicle flap or simply excised to allow space for the proximal portion of the transposition flap. Since the operation works well for total lower lid reconstruction, we have found it simpler to excise the normal temporal lid tissue.

ANATOMY

We believe that the tarsoconjunctival flap retains much of its vascularity through its conjunctival plexus. In most instances, the pedicle contains terminal branches of the superficial temporal and transverse facial arteries. Despite its narrow base, the flap blanches with pressure, recolors with release of pressure, and oozes blood from its raw surface. It is possible, however, that the tip of the flap acts as a free graft.