Early partial division of a hughes tarso-conjunctival flap with secondary intention healing of the anterior.

A 61-year-old man had a highly myopic amblyopic right eye since birth but retained good unaided vision of 6/5 in his left eye. He presented with an enlarging lesion of his left lower lid. The clinical appearance was consistent with a large basal cell carcinoma. Excision biopsy resulted in a defect measuring 18mm horizontally and 8mm vertically. The left eye was padded for 2 days and urgent paraffin section histology confirmed complete excision of a basal cell carcinoma. The lower lid defect was repaired with a Hughes tarsoconjunctival flap and the eye was padded for a further 5 days to aid the healing process. At this time, the flap was partially divided at the medial end to allow earlier visual rehabilitation, whilst the undivided lateral part of the flap continued to provide lift. The anterior lamella was left to heal by secondary intention and division of the remaining lateral portion of the flap was finally completely divided 4 weeks later by which time the anterior lamella was well healed. Both functional and cosmetic results were very satisfactory.