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A technique for the reconstruction of lower eyelid marginal defects
  1. Ingemarie Moesen,
  2. Dion Paridaens
  1. The Rotterdam Eye Hospital, Department of Oculoplastic and Orbital Surgery, Rotterdam, The Netherlands
  1. Dion Paridaens, Department of Oculoplastic and Orbital Surgery, The Rotterdam Eye Hospital, Schiedamsevest 180, 3011 BH Rotterdam, The Netherlands; paridaens{at}


Objectives: To report on a new one-step technique for the reconstruction of lower eyelid marginal defects.

Method: Retrospective case series of 5 patients with lower eyelid basal cell carcinomas abutting the eyelid margin. In all patients, the tumour was radically excised with a 3-mm clear cutaneous margin and a 2-mm tarsoconjunctival margin under frozen section control. Defect size ranged from 12 to 22 mm horizontally and from 8 to 9 mm vertically. For eyelid reconstruction, the 2-mm residual lower lid tarsus was advanced superiorly on a conjunctival pedicle and sutured into the posterior lamella defect. The anterior lamella was reconstructed with orbicularis muscle advancement and a free skin graft from the ipsilateral upper eyelid.

The outcome following surgery was assessed using a subjective scoring system with 4 subsequent grades (poor, adequate, good, excellent).

Results: At 1 week postoperatively, adequate viability of the grafts was noted in all patients. One patient developed transient punctate epithelial keratopathy. After a mean follow-up of 10 months (range 1 to 21 months) the outcome was “poor” in 0 patients, “adequate” in 0 cases, “good” in 1 case and “excellent” in 4 cases.

Conclusion: Reconstruction of small to large lower lid marginal defects with local tarsoconjunctival flap advancement combined with orbicularis muscle advancement and free skin graft is associated with a good functional and cosmetic outcome and limited donor-site morbidity.

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  • Competing interests: None.

  • Funding: SWOO-Flieringa Foundation, Rotterdam, The Netherlands.