Reconstruction of the Posterior Lamella of the Lower Eyelid Using a Long L-Shaped Periosteal Flap: Technical Modification and Literature Review

TL;DR

A new surgical technique using a long L-shaped periosteal flap successfully reconstructs the lower eyelid's posterior lamella.

Contribution

The novel use of a long L-shaped periosteal flap for lower eyelid reconstruction is introduced and validated through two patient cases.

Findings

The long L-shaped periosteal flap effectively reconstructs the posterior lamella of the lower eyelid.

Mild sagging was observed in one case at 1-year follow-up, but no major complications occurred.

Abstract

Free tarsal grafts, the palatal mucosa, and auricular cartilage are commonly used in the reconstruction of the posterior lamella of the eyelid. However, reports describing the sole use of periosteal flaps are limited. We described the cases of two female patients, aged 72 and 85 years, with sebaceous gland and basal cell carcinomas of the left lower eyelids, respectively, who underwent reconstruction with a long L-shaped periosteal flap. The periosteal flap, measuring approximately 6 × 25 mm, was harvested along the vertical axis over the lateral orbital rim, extending across the frontozygomatic suture with the pivot positioned posteriorly at Whitnall's tubercle. This technique enabled the reconstruction of the posterior lamella of the lower eyelid. At the 1-year follow-up, mild sagging of the reconstructed area was observed in the second case; however, no major complications occurred. Thus, the long L-shaped periosteal flap was useful for reconstructing the lateral lower eyelid.

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