Lower eyelid reconstruction with combined sliding tarsal and rhomboid skin flaps

Purpose: To report results in patients undergoing lower eyelid reconstruction following Mohs surgery using a combination of surgical techniques, the rhomboid skin flap and a sliding tarsal flap. Methods: An IRB approved, retrospective case series of patients undergoing surgery between April 2007 and October 2014. Outcomes include establishment of a functional eyelid, quality of postoperative eyelid margin contour, and postoperative complications. Results: During the study period, sliding tarsal flaps were used to repair marginal lower eyelid defects in 32 patients. Coexisting anterior lamellar defects were repaired with a modified rhomboid skin flap in 24 patients, a full thickness skin graft in 4 patients, and combined skin graft and rhomboid flaps in 4 patients. The average width of the marginal defects was 11.3 mm (range: 7-19 mm). Reconstruction resulted in a functional lower eyelid in all patients, the majority having an excellent cosmetic result (n = 20). Minimal contour abnormalities were present in 9 patients, while 3 patients developed a noticeable notch following surgery. Patients repaired with a rhomboid flap were more likely to have isolated postoperative misdirected lashes (5/24) than those repaired using a skin graft with or without a flap (0/8). Conclusion: Combined sliding tarsal and modified rhomboid skin flaps are an effective method of repairing superficial defects of the lower eyelid margin. This tissue-preserving technique maintains the ability to perform subsequent upper eyelid tarsoconjunctival flaps and lateral canthal procedures should a future need arise. Isolated misdirected lashes and minor contour abnormalities are the most common complications of the procedure.