Partial and total lower Lid reconstruction : our experience with 41 cases

Purpose: To report our experience on lid reconstruction in patients with epitheliomas. Methods: A total of 41 consecutive patients affected by basal cell (n = 32) or squamous cell carcinoma (n = 9) underwent partial (n = 35) or total (n = 6) surgical demolition of the lower lid. Surgical defects <25% (n = 10) received direct closure. If the defect involved 30-60% of the eyelid (n = 21), a Tenzel semicircular flap or lateral advancement flap with a free mucosal graft was used. If the entire lid or a major part of the outer lamella had to be reconstructed (n = 10), a cheek advancement flap was used, with a free mucosal graft if the posterior lamella was involved. The success rates and the cosmetic and functional results were evaluated. Results: All 21 flaps used for partial reconstruction remained viable, whereas 1 of the 10 cheek flaps developed partial distal necrosis. Of the 27 mucosal grafts, 2 had to be removed for total necrosis, and 2 developed partial necrosis. In all cases, normal lid function and acceptable cosmetic results were obtained. Complications occurring in 4 cases (1 ectropion and 3 epiphora) were successfully managed with appropriate surgical procedures. Conclusions: Local flaps are the gold standard for lower lid reconstruction as they are highly reliable and guarantee optimal results. The technical details described in this study can help in achieving such results.