Finger's continuous bipedicle conjunctival flap

Purpose

To describe a bipedicle conjunctival flap technique that offered symmetrical, thus structurally stabile, double-vascularized ocular surface reconstruction.

Principal results

A unilateral, inferior, severe corneal neovascularization with subepithelial fibrosis and partial limbal stem cell deficiency evolved over 1 year, covering 270 degrees of the cornea. There was no history of ocular trauma, chemical injury, pharmacologic drops, prior incisional conjunctival or retinal surgery. Ophthalmic oncology and uveitis evaluations were negative. Due to progressive covering of the visual axis, an excisional biopsy followed by a novel “bucket-handle” bipedicle conjunctival flap was performed. Superior bulbar conjunctiva was mobilized and advanced to cover the entire defect and sewn to the margin of conjunctival resection. Then, a central conjunctival corneal window was resected to expose the cornea and allow for vision. However, it also allowed for one continuous, vascularized conjunctival nasal to temporal pedicle flap.

Major conclusion

A “bucket-handle” conjunctival flap provided a continuous bipedicle, arcuate tissue replacement, and a structurally stable barrier to conjunctival regrowth.