Triple-Flaps for lateral canthus reconstruction: A novel technique
A 45-year-old female patient presented with pigmented lesion of the right periocular region which was gradually progressive in size and painless since 2 years. On external examination there was a brownish-black colored nodular mass involving the lateral 1/8 of upper eyelid, lateral 1/ 3 of the lower eyelid and the lateral canthus []. The rest of the anterior and posterior segment examination was normal. The ocular movements were full and free. A clinical diagnosis of basal cell carcinoma of the right eyelid was made. Complete excision of the tumor with 4mm of clear margin involving full thickness of the eyelids and lateral canthus tendon was done leaving behind deeper fibers of the pre-septal orbicularis oculi muscle. Following excision biopsy, the residual defect involved the lateral ¼ of upper eyelid, lateral ½ of the lower eyelid and the lateral canthus []. The defect was repaired by a novel triple-flap technique in which the lateral ¼ of the posterior lamellar defect of the lower eyelid was covered by periosteal flap (first flap) raised from the lateral orbital rim []. The residual central ¼ was covered by a tarsoconjunctival flap (second flap) from the upper eyelid []. The lateral end of the tarsus of the upper eyelid was sutured to the base of the periosteal flap at the level of lateral canthal angle. The residual anterior lamellar defect of the upper eyelid and the lower eyelid was covered by a temporal advancement flap (third flap) after dividing into two parts []. The central ¼ defect of the anterior lamella of the lower eyelid was covered by skin graft taken from the pre-auricular region []. Histopathological examination confirmed the diagnosis of nodulo-ulcerative type of basal cell carcinoma and all the resected margins were free from the tumor. The post-operative period was uneventful. The patient was doing well at three month follow up visit, with no recurrence of the tumor [].