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Principles of eyelid reconstruction: 
Full thickness upper lid reconstruction

Defect of lid beyong 25% of the horizontal dimension of the upper lid cannot usually be closed directly. 

Figure 2a

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 tendon (Figure2b)
  • 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.

Figure 2b

Figure 2c. The dotted line represents the orbital rim. Ideally, the flap should not extend beyong the rim as the skin in this region is thicker and more likely to form scar. 

Figure 2d

More lid defects