A Prefabricated Free Flap for Eyelid Reconstruction
Joseph A. Molnar, M.D., Ph.D.
Ji-Geng Yan, M.D.
Hani S. Matloub, M.D.
Abstract
Patients with severe soft-tissue trauma to ipsilateral upper and lower eyelid and surrounding structures represent a reconstructive challenge. We present a new approach to eyelid reconstruction by creating a prefabricated free flap from the contralateral lower eyelid. New Zealand white rabbits were anesthetized and the central artery and vein of the ear were mobilized and placed in a subcutaneous tunnel in the lower eyelid. After a delay procedure, flaps were made that measured 50% of the lower lid. In an initial group (n=9), the flaps were harvested at three weeks, and injected with Microfil to demonstrate visual and radiologic patency and perfusion from the neopedicle. In a subsequent group of animals (n=6), full-thickness defects of 50% of the left upper lid were created. Prefabricated free flaps from the right lower lid were transferred anastomosing to the central artery and vein on the side of the eyelid being reconstructed. Tissue removed from the upper eyelid was placed in the defect of the lower lid donor site to serve as a control. Flaps were followed for periods of up to 6 months documenting results photographically and by injection. Prefabricated free flaps from the lower eyelid maintained long term patency and full-thickness prefusion from the pedicle, and maintained size, shape, and accessory skin appendages better than composite graft controls. We conclude that prefabricated free flaps may be used to reconstruct eyelid defects. A surgical technique for application to human subjects is proposed.
Molnar JA, Yan J, Matloub HS. A prefabricated free flap for eyelid reconstruction. Journal Reconstructive Microsurgery. Vol 14;(7) 479-482, October 1998.
Wake Forest University, Bowman Gray School of Medicine, Department of Plastic & Reconstructive Surgery, Medical Center Boulevard, Winston-Salem, North Carolina, 27157.