Success of Myocutaneous Flaps Without Posterior Lamellar Reconstruction for Large Full-Thickness Eyelid Mohs Defects.

Background: For full-thickness Mohs eyelid defects, closure involves reconstruction of the posterior lamella (conjunctiva and tarsus) and anterior lamella (skin and orbicularis muscle).

Objective: This study examines the necessity of dedicated posterior lamellar reconstruction in the repair of large, full-thickness eyelid defects based on functional and histologic analysis of the posterior margin without dedicated reconstruction of the posterior mucosa.

Methods: A case series of consecutive large Mohs eyelid defects (>50% loss of palpebral conjunctiva) repaired with myocutaneous flaps without dedicated posterior mucosal reconstruction were reviewed. Postoperative complaints were recorded. Biopsies of the posterior eyelid were reviewed from 4 patients during scheduled 4- to 6-week secondary separation of interpolated flaps or debulking.

Results: Twenty-six cases were identified, of which 16 (62%) lost >90% of the involved eyelid. A variety of flaps were employed (paramedian/glabellar, Fricke, nasolabial rotation, Mustarde) with good outcomes. Complications were uncommon and infrequent. All 4 biopsy specimens showed "squamous epithelium," "conjunctival epithelium," or "mucosa" without evidence of keratinization.

Conclusion: This series suggests that posterior mucosa reconstruction may not be necessary in cases of full-thickness eyelid defect repair as large myocutaneous flaps may act as a matrix for de novo regeneration, or extension, of conjunctival-like squamous epithelium on the posterior eyelid.