Tarsoconjunctival flap survival may not depend on blood supply from the flap

This study assessed blood perfusion in tarsoconjunctival flaps in patients with large lower eyelid defects from tumor surgery.

Study design

The authors prospectively evaluated blood flow at different areas of the tarsoconjunctival flap using laser Doppler velocimetry in 2 patients and laser speckle contrast imaging in 11 patients.

Outcomes

The analysis revealed limited blood flow in the proximal areas of the flap (i.e., 19% at the base and 11% in the middle) and minimal blood flow (4%) towards the distal end of the flap. All flaps survived without any instances of tissue necrosis.

Limitations

The methods used in this study cannot accurately measure small amounts of blood flow. The measurements were only performed intraoperatively, not postoperatively.

Clinical significance

Tarsoconjunctival (Hughes’) flaps appear to provide limited blood flow, and some of the nutrients to the flap may instead come from the tear film. These data support earlier division of the flap. However, additional studies are needed to determine whether the tear film can support simultaneous completely free anterior and posterior lamellar grafts to reconstruct large full-thickness eyelid defects.