Keywords
myocutaneous flap
complex eyelid defect
How to Cite
Abstract
In press
Background. Reconstruction of large lower eyelid defects is a complex problem that requires simultaneous restoration of the structural framework, lacrimal drainage function, and an aesthetically acceptable appearance. Combining these goals remains a challenge in reconstructive surgery.
Aim. To evaluate the effectiveness of a combined two-stage technique for lower eyelid reconstruction using a rotational flap from the upper eyelid, autografts of oral mucosa and cartilage, for functional and aesthetic restoration in a patient with a complex post-oncological defect.
Materials and Methods. The paper presents a clinical case of reconstruction in a 38-year-old female patient with a complete absence of the lateral part of the lower eyelid. The technique involved two stages: 1) reconstruction of the posterior lamella with an oral mucosal graft and coverage of the defect with a rotational Tripier myocutaneous flap from the upper eyelid; 2) after 6 months – restoration of the lower eyelid framework using cartilage grafts from the nasal tip and palate, combined with simultaneous rhinoplasty and blepharoplasty of the contralateral eyelid. Results were assessed based on eyelid height, tear film status (Schirmer's test, fluorescein staining), ability for complete closure, and the patient's subjective satisfaction. This work was conducted as part of the dissertation research "Optimization of the method selection for surgical correction of the periorbital zone" (2025–2029).
Research Ethics. The study complies with the principles of the World Medical Association's Declaration of Helsinki (1964–2024). Informed consent was obtained from the patient for the treatment, participation in the scientific study, and publication of clinical materials and images.
Results. After completing the reconstruction, full functional restoration was achieved: eyelid height and position were normalized, complete closure of the palpebral fissure was restored, and symptoms of dry eye were eliminated (the patient discontinued the use of artificial tears). Schirmer's test showed normal tear production. The aesthetic result was rated by the patient as 9/10 and confirmed by an independent expert evaluation.
Conclusions. The proposed combined two-stage technique, integrating a rotational flap, mucosal and cartilage grafts, is an effective approach for comprehensive functional and aesthetic restoration of complex lower eyelid defects. The method allows for the recreation of anatomical structure, ensures stability of the eyelid margin, and achieves a high level of patient satisfaction.
Keywords: plastic surgery, myocutaneous flap, complex eyelid defect.
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