2020–2021 BCSC Basic and Clinical Science Course™
7 Oculofacial Plastic and Orbital Surgery
Part II: Periocular Soft Tissues
Chapter 11: Reconstructive Eyelid Surgery
Eyelid and Canthal Reconstruction
Lateral Canthal Defects
Laterally based transposition flaps of upper eyelid tarsus and conjunctiva can be used for large lower eyelid defects extending to the lateral canthus. These flaps can be covered with free skin grafts. Semicircular advancement or rhomboid flaps (Fig 11-14) can also be used to repair defects extending to the lateral canthal area. Horizontal strips of periosteum and/or deep temporal fascia left attached at the lateral orbital rim can be swung over and attached to the remaining eyelid margins for reconstruction of the entire lateral canthal posterior lamella (Fig 11-15). A Y-shaped pedicle flap of periosteum can be used for reconstruction of the entire lateral canthal posterior lamella of the upper and lower eyelids.
Figure 11-14 Reconstruction of lateral canthal defect with rhomboid flap. A, Lateral canthal defect after excision of squamous cell carcinoma. B, Rhomboid flap marking. C, Transposition of flaps after tissue undermining. D, Postoperative result 6 months after surgery.
(Courtesy of Bobby S. Korn, MD, PhD.)
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.