|Defect of lid beyong 25% of the horizontal dimension
of the upper lid cannot usually be closed directly.
For defect of between 25% and 66% of the horizontal dimension
( Figure 2a), the following techniques are useful in closing the defect:
lateral cantholysis of the superior crus of the lateral canthal
Tenzel semicircular flap (Figure 2c)
Mustarde lid-switch (Figure 2d). This is based on a small
full-thickness flap of the lower lid based on the marginal artery. The
marginal artery is 3 to 4 mm inferior to the lid margin, and therefore
the pedicle should be at least 3 to 6 mm in vertical height. The lower
lid is closed using a sliding flap from the cheek.