Application of the SCIA-Pure Skin Perforator Flap in Bilateral Upper Eyelid Reconstruction: A Case Report and Review of the Literature.

Abstract

Facial burns often result in cicatricial eyelid retraction, causing corneal exposure, ulceration, and vision loss. Traditional reconstructive methods, such as full-thickness skin grafts or local flaps, frequently fail in extensive burns due to limited healthy tissue and a high risk of recurrent contracture. Achieving durable functional and aesthetic outcomes in such cases remains a major challenge. We report the use of bilateral free superficial circumflex iliac artery pure skin perforator (SCIA-PSP) flaps for upper eyelid reconstruction in a 50-year-old man with severe facial burns and recurrent bilateral upper eyelid retraction, leading to persistent lagophthalmos despite prior skin grafting. Preoperative color Doppler ultrasound was used to map SCIA perforators. Bilateral PSP flaps were elevated from the groin in the subdermal plane and transferred as free flaps to the eyelids, with microvascular end-to-end anastomoses to the supraorbital vessels. The postoperative course was uneventful, with no flap-related complications. At 52 months follow-up for the left eyelid and 31 months for the right, the patient achieved stable bilateral eyelid closure, resolution of lagophthalmos, excellent tissue pliability, and satisfactory aesthetic integration. The SCIA-PSP flap offers ultra-thin, vascularized tissue, effectively preventing recurrent contracture, and represents a reliable alternative in complex burn-related eyelid reconstruction.