DOI: 10.1097/01.PRS.0000156214.52984.C0

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PMID: 15793454

Issn Print: 0032-1052

Publication Date: 2005/04/01


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Surgical Reconstruction of the Palpebral Border: Upper Lid Eyebrow—Musculocutaneous Island Flap

Jorge O. Guerrissi

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Excerpt

The palpebral border reconstruction constitutes a real challenge for plastic surgeons. The loss of palpebral tissues can be a consequence of congenital malformation, tumor resection, or traumatic injury. Not only the skin but also the tarsus, the conjunctival layer, and the eyelashes can be affected.
The palpebral borders have an important function in ocular and corneal protection because of their tissue thickness and because the eyelashes act as a “hair barrier.” The aesthetic aspect is also very important because the anatomical discontinuity of the palpebral border produces an unaesthetic coloboma that cannot be camouflaged.
Although many surgical techniques have been described for palpebral reconstruction, none of them achieves a reliable and specific reconstruction of the border according to aesthetic and functional considerations.1 Triangular border resection and end-to-end closure can be successful if the loss of palpebral border is less than one-third the length; however, when the tissue loss is more than one-third, it is necessary to use other surgical techniques. Usually, current flaps for lid reconstruction are also used for border repair.
In the world medical literature, there is no description of a specific surgical technique for lid border reconstruction. In this article, a new surgical technique for palpebral border reconstruction is described using skin, orbicularis oculi muscle of the upper lid, and hairs of the eyebrow. This skill constitutes a modern indication of the upper lid musculocutaneous flap,2,3 permitting development of a hair-bearing island flap to repair different losses of upper and lower border lids.
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