THE ARROWHEAD SKIN-MUSCLE FLAP IN THE CLOSURE OF LOWER EYELID DEFECTS

Lower-lid defects can arise from many sources, but they are often the result of excision of lower-lid tumors. The excision of the lesion is often performed by means of a pentagonal wedge resection. After repair of the tarsus and reapproximation of the lid margin, the skin and orb icularis are usually closed in a vertical fashion, which is perpendicu lar to relaxed skin tension lines and may extend further down the lid than is optimal as a result of a dog-ear excision. The authors propose a new method for closure of skin and orbicularis muscle in repair of lower eyelid marginal defects. This method is simple and has several a dvantages over vertical closure: it follows relaxed skin tension lines , allows closure of the anterior lamella in the opposite direction fro m the posterior lamella, and leaves an infraciliary scar rather than a vertical scar extending down the cheek. This method has been used in over 100 patients during the past 8 years, and no significant complica tions have occurred. Potential disadvantages of the technique include increased vertical tension and a tendency for the lid to be pulled dow nward. For these reasons, the arrowhead flap would not be the best cho ice in patients with preexisting lower eyelid retraction, cicatricial ectropion, or vertically tight lower-lid skin.