The maximal Hughes procedure

Purpose: To describe the use of oblique medial and lateral periosteal flaps with the Hughes tarsoconjunctival flap for the repair of maximal defects o f the lower eyelid. Methods: A small prospective case series of eight patients requiring lower eyelid reconstruction following with maximal defect of the lower eyelid. Th e patients underwent a Hughes tarsoconjunctival advancement combined with o blique medial and lateral periosteal flaps, and were assessed for aesthetic outcome and surgical complications. Results: All patients had uncomplicated surgery Outcomes assessed included corneal protection, eye closure, lower eyelid retraction, complications, an d patient satisfaction. Eyelid contour and protection was excellent in all patients. Postoperatively, one patient had mild lower eyelid retraction, an d in a second patient, medial ectropion with mild lower eyelid retraction d eveloped that required subsequent revision. Conclusions: The maximal Hughes procedure is a safe and effective procedure that may be performed with patients under local anesthesia and may avoid t he need for more extensive techniques for surgical repair of maximal defect s of the lower eyelid.