Sliding Tarsal Flap for Reconstruction of Large, Shallow Lower Eyelid Tarsal Defects

In Brief Purpose: To describe a novel technique for reconstructing shallow, full-thickness defects of the lower eyelid. Methods: Twelve patients with shallow, full-thickness lower eyelid defects after Mohs excision of eyelid malignancies were treated with this technique. The posterior lamella was reconstructed by obliquely incising the residual tarsus to create medial and lateral tarsal flaps. These flaps were obliquely overlapped to tighten the eyelid and reconstruct a tarsus approximating normal height. The anterior lamella defect was then reconstructed by using local flaps or free grafts in a conventional manner. Results: Eyelid defects ranged from 25 to 40 mm horizontally and 20 to 35 mm vertically, with tarsal defects ranging from 18 to 27 mm horizontally and 2 to 3.5 mm vertically. A stable eyelid margin with good aesthetic appearance was achieved in all patients. Two patients had mild eyelid retraction not requiring intervention, and one had lower eyelid entropion 9 months after surgery. Conclusions: Sliding tarsal flaps are an effective technique for reconstruction of this type of defect. The advantages of this approach are its simplicity, utilization of preserved tissue, and avoidance of the morbidity associated with more complex procedures. A novel technique for reconstructing shallow, full-thickness defects of the lower eyelid, using obliquely constructed, overlapping flaps of residual tarsus, allows direct closure of wide defects while simultaneously tightening the eyelid and reconstructing a tarsus of normal height.