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Sharing techniques using the upper eyelid to reconstruct the lower one have been criticised for causing distortion of the normal upper lid leading to corneal exposure and possible visual disturbance, and for creating second-rate lids. A modification of previously described tarso-conjunctival flap techniques is described which minimises the known complications of earlier methods. A flap of conjunctiva alone is mobilised from the upper eyelid and covered with a full thickness skin graft. A second minor procedure to divide the flap from its donor site is necessary 2 weeks later. Forty-three patients over a 25-year period have undergone total lower eyelid reconstruction with this modified technique and are reviewed with some illustrative cases.
Total or subtotal lower eyelid reconstruction is most commonly performed following tumour resection and only occasionally to correct congenital or traumatic defects. The surgical techniques available still cause controversy (
Byrd, 1983). An upper lid sharing technique has been criticised for possibly causing a shortened or distorted normal lid (
- Byrd H.S.
Selected Readings in Plastic Surgery. 1983; 2: 1
Mustarde´, 1981). A modification of this method is described which has been used for over 25 years and has reduced the morbidity of the procedure, leading to acceptable cosmetic and functional long-term results.
- Mustarde´ J.C.
Major reconstruction of the eyelids: functional and aesthetic considerations.
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© 1987 The Trustees of British Association of Plastic Surgeons. All rights reserved. Published by Elsevier Inc.