The Use of A Unipedicled Orbicularis Oculi Musculocutaneous Flap To Reconstruct Eyelid Deformities

Ted Huang, M.D.

Objectives: A musculocutaneous flap that incorporates a segment of the orbicularis oculi musculature and the overlying skin may be used to reconstruct eyelid deformities that are due to various causes. Our experience of using this flap either to restore lid structures or to incorporate a grafting material for lid reconstruction in patients with involutional changes and burn injuries of the eyelid formed the basis of this report.

Clinical Materials: Over the past 5 years, a total of 23 patients with 43 eyelid deformities underwent reconstructive procedures. There were 18 men and 5 women. The age ranged from the youngest of 3 years to the oldest of 84 years. There were 31 lid deformities due to burn injuries and 12 lids with involutional ectropion. Of lid problems attributable to burn injuries, a complete loss of the upper eyelid structures in one, bilateral blepharophimosis in three patients, lower eyelid ectropion with the problems of conjunctival irritation and epiphora in 24 lids. The upper orbicularis oculi musculocutaneous flap was used in 42 lids and the lower orbicularis musculocutaneous flap in one lid. A segment of ear cartilage was incorporated in 12 lids with involutional ectropion to provide structural integrity. A lower orbicularis oculi MC flap was used to reconstruct the upper eyelid on one side in one patient.

Surgical Techniques: An orbicularis oculi musculocutaneous flap is fabricated in either the upper or the lower eyelid. For the upper orbicularis oculi MC flap, a segment of skin, measured generally 24-25mm in horizontal length and 4-5 mm in vertical width is marked in the upper eyelid. The palpebral line is used as the caudal border of the skin flap. The muscle is separated from the underlying orbital septum via the skin incision. Although the dimension of the underlying muscle segment should be identical to the overlying skin paddle, it may be fashioned either as a medial or a lateral flap by transecting the muscle fibers laterally or medially. The MC flap fabricated is transferred to the site of reconstruction. A grafting material such as a cartilage and mucosal graft may be incorporated into the flap. For the lower orbicularis musculocutaneous flap, the infraciliary line is used as the cephalic border of the skin paddle. The muscle underneath is separated from the anterior wall of the orbital septum. The flap may be fabricated either as a medial or lateral flap. The donor defect is closed primarily, grafted or with a skin flap mobilized from the adjacent area.

Outcomes: There was no flap loss. In one individual, a mild degree of ectropion recurred in the medial corner of the lower lid on both sides due to scar contracture around the cheek. A nasolabial flap was used to correct the deformity.

Conclusion: The orbicularis oculi musculocutaneous flap could be fabricated either in the upper or the lower eyelid to restore the eyelid structure. It is also useful as a carrier of a grafting material that is used to reconstruct lid deformity.