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    Oculoplastics/Orbit

    For full-thickness defects too large to close primarily, but still less than 66%–75% of eyelid width, a Tenzel semicircular flap can be utilized. The upper eyelid can be reconstructed similarly with a superior semicircular flap at the lateral canthus. a. A 50% central eyelid defect is approached with a Tenzel semicircular flap reconstruction. A semicircular incision at the lateral canthus, undermining of skin and orbicularis, and complete cantholysis is required to create the flap. b. The flap is advanced into position and the defect closed in the same fashion as used with a wedge resection. The lateral canthal dissection is closed with interrupted sutures. The advancement creates a flatter incisional contour after the closure, when compared to the original incision. The hashed area on the eyelid margin indicates the area of eyelid that has been advanced