LOWER LID RECONSTRUCTION WITH A CHONDROMUCOSAL ALAR GRAFT AND UPPER LID MUSCULOCUTANEOUS FLAP

Partial or total lower lid reconstruction implies the repair of three layers: the skin, the tarsus, and the conjunctiva. The method of recon struction must, therefore, aim at three objectives: ensuring the stabi lity of the lid by repairing the tarsoconjunctival layer, achieving an aesthetic result with the repair of the skin, and taking into conside ration the primary role of the upper lid in the ocular protective syst em. We recommend a musculocutaneous flap, taken from the upper lid, wi th a single lateral or medial pedicle combined with a chondromucosal a lar graft. During the last 10 years, 41 patients were operated on with malignant skin tumors requiring marginal, partial, and total lower li d reconstruction. The results were quite satisfactory from a functiona l and aesthetic point of view. We noticed two cases of partial flap ne crosis and two cases of ectropion needing revision. We believe that th e procedure described can be a tool in the armamentarium of the plasti c surgeon involved in the field of the orbitopalpebral area.