Tenzel's flap
Tenzel's flap is an useful technique in repairing a lower defect occupying 25 to 66% of the horizontal dimension. The following pictures show the steps used in Tenzel's flap. 

A lower lid basal cell carcinoma involving the margin. The tumour was confirmed on punch biopsy. The defect created will not allow direct closure.

Marking of the tumour  with a 3 mm clear margin. The periorbital flap measures 22mm vertically and 17 mm horizontally.

The upper lid is stretched to show the exact marking of the periorbital flap.

Following the tumour excision. There is a 70% defect of the lower eyelid.

The excised lesion is marked with stitches of different length and sent for histology.

The periorbital flap is created by dissecting through the skin and the orbicularis. Cantholysis is performed in the lateral canthus.

The lid defect is sutured first before the periorbital flap. Deep suture is used to attach the centre of the flap to the underlying structure to prevent the formation of haematoma.

The final appearance of the Tenzel's flap.
More oculoplastic pictures