Periosteal flaps allow for single stage reconstruction of larger full thickness eyelid defects: a retrospective study

• Published in: Archives of dermatological research Vol. 315; no. 10; pp. 2833 - 2839
• Main Authors: Blumenthal, Shoshana R., Mohan, Lauren S., Knabel, Daniel R., Mori, Westley, Demer, Addison, Farah, Ronda, Fiessinger, Lori, Mattox, Adam, Maher, Ian
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.12.2023; Springer Nature B.V
• Subjects: Basal cell carcinoma; Dermatology; Eyelid; Medicine; Medicine & Public Health; Melanoma; Micrography; Monocular vision; Original Paper; Reconstructive surgery; Surgeons; Facial reconstruction; Eyelid reconstruction; Periosteal flap; Mohs surgery
• ISSN: 1432-069X; 0340-3696; 1432-069X
• DOI: 10.1007/s00403-023-02689-0

Full-thickness lower eyelid defects after Mohs micrographic surgery are frequently referred out to oculoplastic surgery for reconstruction. Reconstructive options include wedge closure with or without canthotomy/cantholysis and tarsoconjunctival sliding flaps. Defects > 50% of the eyelid margin have traditionally required the two-stage Hughes flap, leaving the patient with monocular vision for 3–6 weeks until pedicle division. To demonstrate single-stage periosteal flaps performed by dermatologic surgeons can result in safe, functional, and cosmetically acceptable repairs for large full thickness eyelid defects, an institutional review board-approved retrospective study of repairs performed by two dermatologic surgeons between January 2017 and July 2021 at the University of Minnesota. Patient demographics, operative notes, and follow-up notes were reviewed. Defect and follow-up photographs were scored using a visual analogue scale to assess aesthetic results. Ten cases were included in the analysis. Six patients were male and the average age was 62 years old. 8/10 were basal cell carcinoma and 2/10 were melanoma. The mean defect was 9.5 cm 2 , with a range of 1–24 cm 2 . The median cosmetic score was 85.8 ± 10.7. There were no serious complications reported. Mohs micrographic surgeons can safely and successfully reconstruct large, full thickness eyelid defects by periosteal flap.