FPRS Periocular reconstruction

Question 1

What are the most common causes for needing eyelid reconstruction?

Answer 1

Eyelid tumor excision followed by trauma

Question 2

What are the lamellae of the eyelid?

Answer 2

Anterior, middle, and posterior

Question 3

What structures make up the anterior, middle and

posterior lamellae of the eyelid?

Answer 3

● Anterior: Skin and orbicularis oculi
● Middle: Orbital septum, orbital fat, and the suborbicularis
fibroadipose tissue
● Posterior: Eyelid retractors, tarsal plate, and conjunctiva

Question 4

Describe the anatomy of the medial canthus?

Answer 4

The medial canthus consists of the lacrimal drainage system and the medial canthal tendon. The medial canthal tendon surrounds the lacrimal sac (creating a “pump”) and splits to form anterior and posterior heads attaching to the anterior and posterior lacrimal crests. The medical canthal tendon
diverges to join the suspensory ligaments of the eyelid, the orbicularis oculi muscle, and the tarsal plate.

Question 5

What types of defects of the upper eyelid can be allowed to heal by secondary intention with acceptable results?

Answer 5

Medial canthal region less than 1 cm and the upper eyelid when not involving the lid margin and less than 5 mm in
diameter

Question 6

What is the maximum defect size of an eyelid that

can be closed primarily?

Answer 6

25% in an adult and up to 45% in elderly patients with

significant lid laxity

Question 7

What is the most commonly used reconstructive
option for a defect that involves more than 50% of
the upper eyelid?

Answer 7

Cutler-Beard flap

Question 8

After a Cutler-Beard flap reconstruction of the upper eyelid, what will the newly reconstructed
eyelid lack?

Answer 8

Eyelashes and tarsus. Tarsus can be reconstructed if desired, but this is not typically done.

Question 9

Describe a Tenzel rotation flap?

Answer 9

Semicircular musculocutaneous rotation flap that recruits redundant skin from the lateral orbit and can be used to
reconstruct defects up to 60% of the width of the upper or lower eyelids

Question 10

Lower eyelid defects of 50% or greater are most commonly reconstructed with what type of flap?

Answer 10

Hughes tarsoconjunctival flap

Question 11

What anatomical layer of the eyelid does the

Hughes tarsoconjunctival flap reconstruct?

Answer 11

Posterior lamella

Question 12

When are Hughes tarsoconjunctival flaps and Cutler-Beard flaps most commonly divided after
initial surgery?

Answer 12

4 to 6 weeks