Orbicularis muscle advancement flap combined with free posterior and anterior lamellar grafts: a 1-stage sandwich technique for eyelid reconstruction

PURPOSE: To report on a new 1-stage technique for eyelid reconstruction.

DESIGN: Retrospective interventional case series.

PARTICIPANTS: Thirteen patients with shallow full-thickness lower eyelid defects (n = 12) or a full-thickness upper eyelid defect (n = 1) after tumor excision. Defect size ranged from 5 to 10 mm vertically and from 10 to 22 mm horizontally.

METHODS: For eyelid reconstruction, the orbicularis muscle adjacent to the defect was mobilized, incised vertically, and advanced. The inner surface was covered with a free tarsoconjunctival graft from the (ipsilateral or contralateral) upper lid, and the outer surface was covered with a free skin graft from the (ipsilateral or contralateral) upper eyelid.

MAIN OUTCOME MEASURES: The outcome at 12 months after surgery was assessed using a subjective scoring system with 4 subsequent grades (poor, adequate, good, excellent).

RESULTS: After 5 days of patching, adequate viability of the grafts was noted in 11 of 13 patients. In 2 patients, partial necrosis of the skin graft developed, probably the result of hematoma. Complications included ectropion or lid retraction (3/13), granuloma (2/13), and notching (1/13). Two patients underwent additional block excision. The long-term outcome at 12 months after surgery was poor in 0 cases, adequate in 2 cases, good in 7 cases, and excellent in 4 cases.

CONCLUSIONS: The sandwich technique for eyelid reconstruction comprises the use of an orbicularis oculi muscle advancement flap, which is covered with a free graft on both sides. It allows for 1-stage reconstruction of relatively shallow lower eyelid defects with a horizontal size of up to 70% of the total eyelid width and may be a 1-stage alternative to the modified Hughes flap in selected cases.