Aesthetic and functional outcomes following reconstruction of full-thickness lower eyelid defects using Hughes flap and orbicularis oculi muscle flap: A case series study.

Reconstruction of full-thickness lower eyelid defects remains a clinical challenge due to the aesthetic and functional demands of the periorbital region lower eyelid. Reconstruction using a Hughes flap for the posterior lamella and orbicularis oculi muscle flap for the anterior lamella following malignant tumor excision has not been sufficiently detailed in the literature. We therefore retrospectively evaluated the outcomes of seven patients who underwent this technique, including assessment by photographic analysis and ophthalmological evaluations at least 6 months postoperatively. Eyelid morphology was quantitatively evaluated by measuring Margin Reflex Distance (MRD)-1, MRD-2, eyelid curvature, Δpeak-pupil distance, and horizontal palpebral fissure length using Image J software. Ocular surface condition was assessed by tear break-up time (BUT), superficial punctate keratopathy (SPK) scoring, and Japanese Ocular Surface Disease Index. The median age of patients was 76 years, and basal cell carcinoma was the most common diagnosis. MRD-1 and Δpeak-pupil were significantly increased after surgery (p = 0.031, p = 0.046, respectively). MRD-1 of the reconstructed side was also significantly higher than the contralateral side (p = 0.029). No significant differences were observed in MRD-2, eyelid curvature, or horizontal fissure length. BUT and SPK scores showed no significant differences between sides, and patient-reported symptoms were generally mild. No cases of ectropion or entropion occurred. All flaps survived completely, and there was no recurrence during the follow-up period. Reconstruction using a Hughes flap combined with an orbicularis oculi muscle flap seems to provide favorable lower eyelid contour and to preserve ocular surface function.