Superiorly Based Tarsoconjunctival Advancement (Hughes, Landholt, Köllner) Flap for Reconstruction of The Lower Eyelid



Superiorly Based Tarsoconjunctival Advancement (Hughes, Landholt, Köllner) Flap for Reconstruction of The Lower Eyelid


M. A. CALLAHAN



This is one of the oldest, time-tested flaps for eyelid reconstruction. It will result in a reconstructed eyelid of excellent color match, thickness, and function (1, 2, 3, 4, 5) (Fig. 15.2). The tarsoconjunctival flap for lower eyelid reconstruction supplies the deficient lower lid with conjunctiva for lining and tarsus for structural support. This posterior lamella flap should be combined with a free skin graft (or skin flap) to create the new anterior lamella of the lower lid.

Note that, as originally described, the upper eyelid was split along the gray line. Because of associated complications, this flap achieved a bad reputation. It is no longer performed as originally described, and even Dr. Hughes warns against splitting the upper eyelid (6).




OPERATIVE TECHNIQUE

Figure 15.1 illustrates resection of a lower lid tumor well below the lower lid tarsal plate, leaving a 5- to 7-mm vertical defect. Two 4-0 silk sutures are placed along the upper lid margin, being careful to avoid the lash follicles, to evert the lid and expose the inner tarsal surface (Fig. 15.2B). The sutures are anchored to the drapes with hemostats. A horizontal mattress “tension” suture is placed across the lower lid defect to hold the wound edges in position temporarily, so that the width of the tarsoconjunctival flap can be estimated. The tension of the suture should be adjusted to approximate that of the normal lid. Alternatively, the width of the tarsoconjunctival flap can be estimated before the malignant lesion of the lower lid is resected.

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Jun 26, 2016 | Posted by in General Surgery | Comments Off on Superiorly Based Tarsoconjunctival Advancement (Hughes, Landholt, Köllner) Flap for Reconstruction of The Lower Eyelid
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