A New Technique for Reconstruction of Medium-Sized Eyelid Defects (A Modification of Tessier Nasojugal Flap)

Eyelid reconstructions are considered challenging surgical procedures, which are
mostly performed due to trauma, tumor resections, and congenital defects. Several
techniques can be used to reconstruct the lower eyelid defects. In this study, the
authors aimed to introduce a new single-step technique for the reconstruction of
medium-sized lower eyelid defects while preventing ectropion. A modified nasojugal
flap was designed and harvested after making a complete incision. A dermal extension
from the nasolabial area was added to the end of the nasojugal flap. A tunnel was
created under the orbicularis oculimuscle, and the dermal tail was passed through this
tunnel toward the lateral canthus. The flap was fixed in its new position by suturing. The
defect in the nasojugal area was repaired by bilateral advancement of the surrounding
tissue. The recovery of the patients was followed up for 6 months, which included
assessment of the eyelid position and donor sitemorbidity. A total of four patients with
an age range of 64 � 8 years who suffered frombasal cell carcinoma were treated using
the technique introduced in this study. No ectropion or abnormal eyelid position nor
donor site morbidity was observed during the follow-up period. Reconstruction of a
medium-sized lower eyelid defect using nasolabial flap with local modification combined
with orbital canthus fixation resulted in appropriate functional and cosmetic
outcomes and limited the risk of complications and morbidity