Repair of eyelid and periocular soft tissue defects with Pacman flap

Objective To explore the effectiveness and safety of Pacman flap for repair of eyelid and periocular soft tissue defects. Methods The clinical data of 12 patients who underwent repair of eyelid and periocular soft tissue defects with Pacman flap between April 2015 and September 2020 was retrospectively reviewed. There were 5 males and 7 females, aged from 18 to 87 years, with a median age of 63 years. The disease duration ranged from 6 months to 50 years, with a median time of 3 years. The defect was located on the lateral eyelid in 5 cases, inferior eyelid in 3 cases, inferior and medial eyelid in 2 cases, inferior and lateral eyelid in 2 cases, and lateral eyebrow in 1 case. Pathological diagnosis included 4 cases of basal cell carcinoma, 4 cases of squamous cell carcinoma, 1 case of junction nevus, 1 case of intradermal nevus, 1 case of seborrheic keratosis, and 1 case of keratoacanthoma. The size of defects ranged from 1.4 cm×1.2 cm to 5.5 cm×5.0 cm. According to the skin mobility and toughness around the defects, Pacman flaps with the size of 1.6 cm×1.4 cm to 10.0 cm×6.0 cm were designed and advanced to repair the defects. Results All flaps survived completely with no necrosis. One patient had infection, and another patient had partial wound dehiscence, but the wounds healed after dressing change without further debridement. Other patients all recovered successfully. The follow-up time ranged from4 to 51 months, with a median time of 12 months. No recurrence and metastasis occurred, and the scars were invisible without deformity of eyelid and brow. All patients were satisfied with the aesthetic and functional outcomes of the eyes. Conclusion Pacman flap is a simple and feasible technique for repair of eyelid and periocular soft tissue defects, with satisfactory effectiveness.