A Simple Technique of Closing a Large Lower Eyelid Defect

1. Chiang-Ling Koay
2. Siew-Leng Ting
3. Chek-Tung Ngo
4. Chung-Nen Chua

Department of Ophthalmology, University Malaysia Sarawak, Malaysia

Purpose: To describe a simple technique of closing a large left lower lid defect after removal of a left lower lid basal cell carcinoma

Methods: We describe a case report of a 78 year old frail gentleman due to multiple medical problems who had a left lower lid basal cell carcinoma of 3 years duration whom we performed a wide excision which left a rather large defect and repaired it with a simple myocutaneous nasojugal flap. Many other more complicated such as the Hugh's flap, chondral mucosal grafts with local skin flaps and chondral-perichondrial flaps coated with local skin flaps were considerations but considering the need for these procedures to be done under general anaesthesia and being more labourious, we opted for a local nasojugal myocutaneous flap less the defect to close the defect caused by the excision of the lesion. All these were done under local anaesthesia and the procedure took less than half an hour.

Results: At 2 weeks and 2 months follow-up, we were pleased to see that the flap provided good functional and anatomical results. There was no ectropion and the cornea was not in any way damaged. There was however just mild epiphora. The scar from the donor and the graft site had imperceptible scars.

Conclusions: We recommend this novel technique as an alternative of closing a lower lid defect in elderly and frail patients whereby long and labourious surgeries such as mentioned above would not be feasible.