Tarsal-Conjunctival Graft or Flap and Skin-Muscle Transposition Flap in Lower Eyelid Reconstruction
Lower eyelid reconstruction requires multiple tools in an oculoplastic surgeon’s armamentarium. Although the tarsoconjunctival (Hughes) flap is reliable, the requirement of a second stage and closure of the eye are definite disadvantages to the procedure. In addition, some defects are in the gray zone between a primary closure with cantholysis and a Hughes flap. This chapter describes two different one-stage procedures for reconstruction of large full-thickness defects of the lower eyelid: one procedure employs a free tarsal graft, while the other uses a laterally based tarsoconjunctival flap.