Advanced carcinoma of the eyelids. Principles of plastic reconstruction after excision

BACKGROUND: We present the surgical methods and results of operations in cases with advanced carcinoma of the eyelids over a 5-year period. METHODS: The study included 71 patients with advanced mono- and multifocal carcinoma (n=76) of the eyelids, selected from 324 consecutive cases with tumors of the eyelids. Various reconstruction techniques were performed after frozen section control. RESULTS: Thirty-two defects at the medial canthus were handled by glabellar transposed flap. A "dog-ear" fold occurred in three cases of this group. Twelve defects of the lower eyelid were closed by transposed nasojugal flap and 21 defects at the lateral canthus by advancement flap without any complications. For the reconstruction of three large upper eyelid defects, the Cutler-Beard procedure was applied. The Mustarde cheek rotation flap with and without skin graft was used in eight patients with large defects of the lower lid. A small part of the skin graft became necrotic in two patients of this group. CONCLUSIONS: We recommend the described surgical techniques for the reconstruction of large eyelid defects. These are successful procedures with good therapeutic, functional and esthetic results. The choice of the method depends on the individual assessment of the patients.