Techniques of Eyelid Reconstruction: Flaps and Grafts

The choice of eyelid reconstruction depends on the size of the defect, the patient’s age, medication, and choice, and surgeon’s preference. Reconstruction ‘rules’ include: replacing like-with- like, minimizing vertical tension, maximizing horizontal tension, and choosing the simplest, preferably one-step technique. Reconstruct both the anterior and posterior eyelid lamellae. Ensure adequate vascularity of the flap pedicle or graft recipient bed. A vascularized orbicularis muscle flap can be used to feed free posterior and anterior lamellar grafts. Aim to reconstruct a normal eyelid margin in the pre-corneal area to avoid interface keratopathy. Consider laissez-faire, particularly for superficial medial canthal defects and selected margin defects. Avoid donor site morbidity.