Laterally Based Transverse Musculocutaneous Flap for Lower Eyelid Reconstruction
C. D. BUCKO
It is recommended that this flap be used as a musculocutaneous flap to ensure circulation to the distal end of the skin flap. We feel that the modification presented in this chapter is a significant advance over the original Fricke flap (that was harvested from the area above the eyebrow).
One of the best flaps that can be used to reconstruct the lower eyelid is a laterally based transverse musculocutaneous flap from the upper eyelid.
This flap can be used to replace tissue loss from the lateral two-thirds of the lower lid resulting from trauma, tumor excision, and congenital colobomata. More specific applications are (1) to replace lost skin and muscle of the lateral two-thirds of the lower lid and cheek of up to 15 to 20 mm in vertical height, (2) to replace a full-thickness loss of the lateral two-thirds of the lower lid of up to 15 to 20 mm in vertical height, (3) to reconstruct lost lateral canthal soft tissue, and (4) to fill in the defect when raising the position of the lateral lower lid margin (as a result of congenital or severe senile ectropion or Treacher Collins syndrome) (1, 2, 3, 4).
The flap is simple to design and execute; it is a safe flap with a good blood supply. Texture and color are similar to that of lost tissue, and the flap can be used as a full-thickness replacement, if a graft is included on the undersurface. The donor site is invisible, and there is no functional loss in the donor area, since tissue is usually in excess in adults.
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