ABSTRACT
Patients with severe soft-tissue trauma to the ipsilateral upper and lower eyelid
and surrounding structures represent a reconstructive challenge. The authors present
a new approach to eyelid reconstruction, by creating a prefabricated free flap from
the contralateral lower eyelid. New Zealand white rabbits were anesthetized, and the
central artery and vein of the ear were mobilized and placed in a subcutaneous tunnel
in the lower eyelid. After a delay procedure, flaps were made that measured 50 percent
of the lower lid area. In an initial group (n = 9), the flaps were harvested at 3
weeks, and injected with Micro-fil, to demonstrate visual and radiologic patency and
perfusion from the neopedicle. In a subsequent group of animals (n = 6), full-thickness
defects of 50 percent of the left upper lid were created. Prefabricated free flaps
from the right lower lid were transferred, anastomosing to the central artery and
vein on the side of the eyelid being reconstructed. Tissue removed from the upper
eyelid was placed in the defect of the lower lid donor site to serve as a control.
Flaps were followed for periods of up to 6 months, documenting results photographically
and by injection. Prefabricated free flaps from the lower eyelid maintained long-term
patency and full-thickness perfusion from the pedicle, and also maintained size, shape,
and accessory skin appendages better than composite graft controls. The authors concluded
that prefabricated free flaps may be used to reconstruct eyelid defects; a surgical
technique for application to human subjects is proposed.
