Total Lower Lid Reconstruction

The entire lower lid can be reconstructed with a transposition flap (Fig. 9.11a, b) or a bipedicle flap (myocutaneous flap, Fig. 9.12a, b) from the upper eyelid (Tripier flap). As in other methods, a chon-dromucosal graft from the nasal septum can be used for lining (see Figs. 9.6 and 9.7). The lateral and medial pedicles are divided and inset in a later sitting.

Fig. 9.7 Lower lid reconstruction using the rotation-advancement technique of Mustarde (1980).

a The mucosal defect is reconstructed with a composite graft from the septum. Note the curved flap incision in the temporal region (see Fig. 9.6; see also Figs. 8.1 and 8.6). b The reconstruction is completed. c The lacrimal ducts are in-tubated with a pigtail catheter and splinted with a small silicone stent.

Buried anchoring sutures (5-0 Vicryl)

13 mm

Buried anchoring sutures (5-0 Vicryl)

13 mm

Lower Lid Flap

Nasolacrimal duct

Silicone stent (ca. 0,32 mm diameter) 0

Nasolacrimal duct

Silicone stent (ca. 0,32 mm diameter) 0

Reconstruction of the Lower Eyelid 99

Lowe Eyelid Flap

Fig. 9.8a, b Transposition flap of von Langenbeck for repairing a lower lid defect and correcting ectropion.

Fig. 9.8a, b Transposition flap of von Langenbeck for repairing a lower lid defect and correcting ectropion.

Pigtail Catheter Suture
Fig. 9.9a, b Median nasolabial flap for repairing a lower lid defect or correcting ectropion.
Tripier Flap

Fig. 9.10 Imre cheek advancement for repairing a lower lid defect or correcting ectropion (see Fig. 8.2).

Reconstruction Upper Lid Defect

Fig. 9.10 Imre cheek advancement for repairing a lower lid defect or correcting ectropion (see Fig. 8.2).

Cheek Advancement Flap

Fig. 9.11 a, b Simple mucocu-taneous transposition flap

(Tripier flap) from the upper lid is used to correct ectropion of the lower lid.

Fig. 9.11 a, b Simple mucocu-taneous transposition flap

(Tripier flap) from the upper lid is used to correct ectropion of the lower lid.

Tripier Flap

Fig. 9.12 Double Tripier flap designed as a bipedicle flap. a The flap is outlined in the upper eyelid as a myocu-taneous flap. b The flap is transposed, eliminating ectropion of the lower eyelid. About 3 weeks later the lateral and medial pedicles are divided and inset (see Fig. 9.3 d, e).

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