[Reconstruction of extensive internal canthus defects involving both eyelids: A four-step surgical approach utilizing a graft-supplying flap].

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.