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    Oculoplastics/Orbit

    For full-thickness lower eyelid defects of 66%–100% of eyelid width, a Hughes tarsoconjunctival flap reconstruction can offer a superior reconstructive result; however, it does require two surgical stages. a. Large lesion involving eyelid margin. b. After excision, a full-thickness defect greater than 80% exists. c. Cross-sectional representation of surgical incisions and planes for elevation of a Hughes tarsoconjunctival flap from the upper eyelid, for use in the lower eyelid. The tarsal incision, shown at 3 mm above the eyelid margin, is the most inferior this incision should be placed. d. The elevated tarsoconjunctival flap is advanced into to the lower eyelid defect to reconstruct the posterior lamella. e. The tarsal edges of the flap are fixated to the cut tarsal edges and inferior fornix conjunctiva with absorbable braided suture. f. The anterior lamella is then reconstructed by advancing skin and orbicularis over the tarsoconjunctival flap. g. Alternatively, the tarsoconjunctival flap can be covered by full-thickness skin graft for replacement of the anterior lamellar defect. h. After complete healing, the flap is divided at its base for the second stage of surgery. Sharp release with a blade or scissors with care to avoid damage to the underlying globe is required.