V-Y Glabellar Skin Flap to The Medial Canthal Region
J. C. MUSTARDÉ
EDITORIAL COMMENT
This is a very good flap; however, the reader should understand that the forehead glabellar skin is much thicker than the eyelid skin.
Tumors at the medial canthus are generally basal cell carcinomas, as they are elsewhere on the eyelids, and they are comparatively slow growing. In the early stages of their development, they may be relatively superficial, and it may be possible to resect such lesions, along with sufficient normal tissue without the need for deep dissection. The defect can then be covered by a full-thickness skin graft. An estimate of the depth of the tumor and the possible involvement of the underlying canaliculi and tear sac may be obtained by injecting a local anesthetic beneath the tumor to see whether it “balloons” off readily from the deep tissue and by the passage of a lacrimal probe.
INDICATIONS
In patients in whom it has been determined that the medial canthal lesion cannot be resected superficially, the degree of hollowing that would be left after an adequate resection would give a poor aesthetic result with skin graft coverage alone. Indeed, if periosteum and even bone are involved, a skin graft would probably not survive. A skin flap with a substantial layer of subcutaneous tissue must be used.
FLAP DESIGN AND DIMENSIONS
One of the simplest and most satisfactory techniques for doing such reconstructions is to bring down the thick glabellar skin as a V-Y flap in a one-stage operation. Depending on the width of skin available between the eyebrows, a flap designed in the form of an inverted V can be used to cover a defect at the medial canthus of up to 15 mm in diameter (Fig. 27.1). In conjunction with other flaps, such a flap may be employed to cover even larger areas. The flap is incised down to the galea aponeurotica, leaving an adequate pedicle on the bridge of the nose. The vertical dimension of the flap should be about three times the breadth at its lowest part. Once the flap has been slid down to cover the defect, it will be found that the forehead wound can be closed in the form of an inverted Y.
V-Y Forehead Flap Combined with Lower Eyelid Reconstruction
Where resection at the medial canthus is carried out with resection of part of an eyelid, it is usually the lower eyelid that is more involved. If it is not possible to close the lower lid defect by direct approximation of the cut surface of the tarsal plate to periosteum, a formal cheek rotation flap reconstruction of the lower lid can be carried out in the manner described in Chapter 13 (Fig. 27.2) (1).
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