Outcomes of Centrally versus Laterally Based Tarsoconjunctival Pedicle Flap Reconstruction for Large, Full-Thickness Lower Eyelid Defects.

Background: The purpose of this study was to compare the outcomes of 2 types of tarsoconjunctival pedicle flaps for reconstruction of large lower eyelid defects.

Methods: The authors performed a retrospective medical record review of consecutive patients who underwent centrally or laterally based tarsoconjunctival pedicle transconjunctival flap for lower eyelid reconstruction for defects greater than 50% of the lid margin. Full-thickness skin grafts were used for anterior lamellar reconstruction in all cases. The primary outcome measure was eyelid position, function, and satisfactory appearance.

Results: A total of 43 patients were identified. Twenty-six patients underwent reconstruction with a centrally based tarsoconjunctival pedicle flap; 17 patients underwent reconstruction with a laterally based tarsoconjunctival pedicle flap. The average size of the lid defect was 77.7% (range, 50% to 100%) in the central group and 75% (range, 50% to 100%) in the lateral group ( P = 0.604). Mean follow-up time was 61.5 weeks in the central group and 46.6 weeks in the lateral group ( P = 0.765). After division of the flap and during follow-up, 27% of the centrally based group required revisional surgery, versus none in the laterally based group ( P = 0.03). All the patients with centrally based flaps required second-stage flap division, whereas only 52% of patients with a laterally based flap underwent second-stage flap division ( P < 0.001).

Conclusion: For reconstruction of large lower lid defects requiring lid-sharing procedures, centrally and laterally based procedures had equivalent functional outcome, but the laterally based group had less need for revisional procedures and may not need a second-stage division of the flap.

Clinical question/level of evidence: Therapeutic, III.