FREE GRAFT ENHANCEMENT USING ORBICULARIS MUSCLE MOBILIZATION

Purpose: The purpose of this article is to demonstrate how mobilizatio n of the orbicularis oculi muscle can improve viability, appearance, a nd function of free skin grafts in the periocular region. By enhancing blood supply with this technique, healing often can be achieved in di fficult reconstructive cases. Methods; Seven patients underwent orbicu laris muscle mobilization before placement of free skin grafts. Two pa tients underwent resection of basal cell carcinomas of the lateral eye lids and canthal region requiring complex reconstructive techniques su ch as lateral canthal tendon reconstruction with auricular cartilage. One patient underwent upper eyelid reconstruction after total resectio n for sebaceous cell carcinoma with pagetoid spread. Two patients had difficult wound dehiscences that were difficult to repair primarily. I n addition, the lower eyelid with recurrent basal cell carcinomas of t wo patients who initially had undergone reconstruction with a Hughes p rocedure was reconstructed using tarsal strip grafts and orbicularis m uscle mobilization combined with a free skin graft Results: All seven patients have viable free grafts to date, and no further problems occu rred in the two patients with wound dehiscences. Follow-up ranges from 1 to 8 years. Conclusion: Orbicularis oculi muscle mobilization can b e combined with a variety of techniques in eyelid and periorbital surg ery, including difficult wound repair, reconstruction of the lateral c anthal tendon with periosteal flaps or auricular cartilage, tarsal tra nsposition flaps, mucosal grafts, and skin grafts. The addition of thi s technique can enhance the blood supply to the reconstructed area and allow healing which might not be obtained otherwise.