Annales de chirurgie plastique et esthetique · 2026
[Reconstruction of extensive internal canthus defects involving both eyelids: A four-step surgical approach utilizing a graft-supplying flap].
СтатьяКлинический случайАннотация на английскомНазвание и аннотация: Перевод в очереди
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Abellan Lopez M, Bertrand B, Philandrianos C, Bardot J, Casanova D
Аннотация
INTRODUCTION: The reconstruction of extensive medial canthal defects involving both eyelids is a rare and complex surgical challenge. The objectives are both functional (preserving mobility and corneal protection) and aesthetic (avoiding a patch-like appearance and restoring the concavity of the canthus).
METHOD: We propose, through a clinical case, a four-step reconstruction procedure: 1) temporary canthopexy: fixation of the tarsal stumps to the orbital rim to protect the cornea while awaiting histopathological results; 2) buccal mucosa graft and frontal flap: a buccal mucosa graft reconstructs the posterior lamella, while a paramedian forehead flap serves as a vascular support ("graft-supplying flap"); 3) frontal flap division and skin graft: after 3-4 weeks, the flap is divided, and the cutaneous-fat layer is replaced with a retroauricular skin graft; 4) reconstruction division and second mucosal graft: a thin buccal mucosa graft covers the incision edges to restore symmetry of the palpebral fissures.
RESULTS: At 6 months, the patient was satisfied. Functionally, there was no lagophthalmos or corneal irritation. Aesthetically, color matching was appropriate, and the concavity of the canthus was restored.
DISCUSSION: The frontal flap and buccal mucosa provide adequate coverage, avoiding complications such as entropion.
CONCLUSION: This multi-stage approach, combining a frontal flap and mucosal grafts, seems to be an effective solution for extensive medial canthal defects involving the eyelids.
METHOD: We propose, through a clinical case, a four-step reconstruction procedure: 1) temporary canthopexy: fixation of the tarsal stumps to the orbital rim to protect the cornea while awaiting histopathological results; 2) buccal mucosa graft and frontal flap: a buccal mucosa graft reconstructs the posterior lamella, while a paramedian forehead flap serves as a vascular support ("graft-supplying flap"); 3) frontal flap division and skin graft: after 3-4 weeks, the flap is divided, and the cutaneous-fat layer is replaced with a retroauricular skin graft; 4) reconstruction division and second mucosal graft: a thin buccal mucosa graft covers the incision edges to restore symmetry of the palpebral fissures.
RESULTS: At 6 months, the patient was satisfied. Functionally, there was no lagophthalmos or corneal irritation. Aesthetically, color matching was appropriate, and the concavity of the canthus was restored.
DISCUSSION: The frontal flap and buccal mucosa provide adequate coverage, avoiding complications such as entropion.
CONCLUSION: This multi-stage approach, combining a frontal flap and mucosal grafts, seems to be an effective solution for extensive medial canthal defects involving the eyelids.