Ideal esthetic and functional full-thickness lower eyelid “like with like” reconstruction using a combined Hughes flap and swing skin flap technique

Published:April 21, 2021DOI:



      A goal in ideal lower eyelid reconstruction is to achieve not only an esthetic recovery of the shape of the eyelid but also to obtain satisfactory eyelid function without damage to the corneal surface. In this report, we introduce our “Like with Like” reconstruction technique using a combined Hughes flap and swing skin flap. The Hughes flap is a tarsoconjunctival pedicled flap from the upper eyelid, and the swing skin flap is a kind of transposition flap based on the orbicularis muscle pedicle.

      Patients and methods

      Eight patients who had more than 25% of the lower eyelid affected by a full-thickness defect were included. There were five men and three women, and the average age was 68.4years old. All patients had undergone wide tumor excision of the lower eyelid due to a malignant tumor and had also had primary two-stage eyelid reconstruction with a combined Hughes flap and swing skin flap.


      The average reconstructive time was 1:20, and no postoperative severe complications such as flap necrosis or wound dehiscence were observed. The follow-up period was an average of one year, and there were no functional problems such as ectropion, lower eyelid retraction, lid margin hypertrophy, lacrimation disorder, or corneal problems observed in any cases. Esthetically, no reconstructed eyelid bulging or asymmetry in the lid margin was observed in any of the cases.


      Combining the Hughes flap and skin swing flap technique might be the best choice for a full-thickness lower eyelid defect with regard to the esthetic and functional results.


      To read this article in full you will need to make a payment


        • Mathijssen I.M.J.
        • van der Meulen J.C.
        Guidelines for reconstruction of the eyelids and canthal regions.
        J Plast Reconstr Aesthetic Surg. 2010; 63: 1420-1433
        • Siegel R.J.
        Palatal grafts for eyelid reconstruction.
        Plast Reconstr Surg. 1985; 76: 411-414
        • Miyamoto J.
        • Nakajima T.
        • Nagasao T.
        • et al.
        Full-thickness reconstruction of the eyelid with rotation flap based on orbicularis oculi muscle and palatal mucosal graft: long-term results in 12 cases.
        J Plast Reconstr Aesthet Surg. 2009; 62: 1389-1394
        • Hashikawa K.
        • Tahara S.
        • Nakahara M.
        • et al.
        Total lower lid support with auricular cartilage graft.
        Plast Reconstr Surg. 2005; 115: 880-884
        • Yang M.
        • Zhao Y.
        Reconstruction of full-thickness lower eyelid defect using superficial temporal artery island flap combined with auricular cartilage graft.
        J Craniofac Surg. 2015; 140: 229-239
        • Cristofari S.
        • Rem K.
        • Revol M.
        • et al.
        Reconstruction of full-thickness lower lid defect using texier's procedure: retrospective assessment of the indications.
        J Oral Maxillofac Surge. 2019; 77: 433-439
        • Uslu A.
        Use of a perforator/subcutaneous pedicled propeller flap for reconstruction of lower eyelid defects.
        J Plast Reconstr Aesthet Surg. 2019; 72: 119-124
        • Ooms L.S.S.
        • Beets M.R.
        • Grosfeld E.C.
        Reconstruction of the lower eyelid using Hughes’ tarsoconjunctival flap: follow up of 28 cases.
        FJ Plast Reconstr Aesthet Surg. 2014; 67: 177-179
        • Hishmi A.M.
        • Koch K.R.
        • Matthaei M.
        • et al.
        Modified Hughes procedure for reconstruction of large full-thickness lower eyelid defects following tumor resection.
        Eur J Med Res. 2016; 21: 27-35
        • Bertrand B.
        • Honeyman C.S.
        • Emparanza A.
        • et al.
        Twenty-Five years of experience with the submental flap in facial reconstruction: evolution and technical refinements following 311 cases in Europe and Africa.
        Plast Reconstr Surg. 2019; 143: 1747-1758
        • Yan H.
        • Ouyang Y.
        • Chi Z.
        • et al.
        Digital pulp reconstruction with free neurovascular toe flaps.
        Aesthetic Plast Surg. 2012; 36: 1186-1193
        • Yamamoto S.
        • Yano T.
        • Furubayashi G.
        • et al.
        A labia majora sharing perforator flap for labial defect reconstruction.
        Plast Reconstr Surg Glob Open. 2020; 8: 2931-2935
        • Fine N.A.
        • Pribaz J.J.
        • Orgil D.P.
        Use of the innervated platysma flap in facial reanimation.
        Ann Plast Surg. 1995; 34: 326-330
        • Jin S.
        • He Y.
        • Tian Z.
        • et al.
        Superificial circumflex artery perforator flap aided by color doppler sonography mapping for like-with-like buccal reconstruction.
        Oral Surg Oran Med Oral Pathol Radiol. 2015; 119: 170-176