Case 02 2026:  Tarsoconjuctival Flap for Eyelid Reconstruction

Ajla Sabitovic; Rikke Børthy Petersen; Nanja Gotland Sundstrup

Journal of Plastic, Breast & Reconstructive Surgery·Informes quirúrgicos de acceso abierto revisados por paresRevisado por pares · Acceso abierto

Case 02 2026: Tarsoconjuctival Flap for Eyelid Reconstruction · JPBRS

Informe de caso

Case 02 2026: Tarsoconjuctival Flap for Eyelid Reconstruction

Ajla Sabitovic, Rikke Børthy Petersen, Nanja Gotland Sundstrup

Publicado 28 de mayo de 2026295 vistas3 min de lectura

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Resumen

This case describes the use of a tarsoconjuctival flap for reconstruction of the lower eyelid following excision of a basal cell carcinoma in a 76-year-old woman. Due to the tumor size, depth and location near the limbus of the eye, direct closure was not possible. The tarsoconjuctival flap was chosen as the preferred reconstructive approach because of its ability to reconstruct all layers of the eyelid. Postoperative follow-up at six months demonstrated satisfactory aesthetic and functional outcomes. Patient medical history A 76-year-old woman presented with a biopsy-confirmed nodular basal cell carcinoma involving the right lower eyelid. Tumor excision was performed in general anesthesia with 3 mm margin and intraoperative frozen-section control, confirming tumor free margins. Resection resulted in a full-thickness defect involving approximately 90% of the lower eyelid. Reconstruction was performed with a tarsoconjuctival flap for the posterior lamella and a Tripier flap from the upper eyelid for the anterior lamella. Before and After Patient examination Clinical examination revealed a 12 x 10 mm elevated ulcerating lesion involving the right lower eyelid, extending into conjunctiva and limbus. Pre-operative considerations The patient presented with a full-thickness defect of the lower eyelid involving conjunctiva and the inferior eyelid margin. Due to the tumor size and location direct closure was not possible. Reconstruction with a flap was therefore required to secure reconstruction of all layers of the lower eyelid to give the eyelid full support and thereby secure its function. 1 Step 1 Preoperative skin markings outlining the tumor and 3 mm excision margin. 2 Step 2 Excision of the tumor was performed with a 3 mm margin, involving the conjunctiva, tarsal plate and lower eyelid

Puntos clave de aprendizaje

Pearls

- Intraoperative frozen-section control
- Preservation of adequate tarsal plate
- Precise flap sizing
- Tension-free flap mobilization
- Appropriate timing of flap division

Pitfalls

- Insufficient tarsal tissue within the flap
- Incorrect timing of flap division
- Risk of postoperative complications

Patient history

A 76-year-old woman presented with a biopsy-confirmed nodular basal cell carcinoma involving the right lower eyelid. Tumor excision was performed in general anesthesia with 3 mm margin and intraoperative frozen-section control, confirming tumor free margins. Resection resulted in a full-thickness defect involving approximately 90% of the lower eyelid. Reconstruction was performed with a tarsoconjuctival flap for the posterior lamella and a Tripier flap from the upper eyelid for the anterior lamella.

Examination

Clinical examination revealed a 12 x 10 mm elevated ulcerating lesion involving the right lower eyelid, extending into conjunctiva and limbus.

Pre-operative considerations

The patient presented with a full-thickness defect of the lower eyelid involving conjunctiva and the inferior eyelid margin. Due to the tumor size and location direct closure was not possible. Reconstruction with a flap was therefore required to secure reconstruction of all layers of the lower eyelid to give the eyelid full support and thereby secure its function.

Paso 1 — Step 1

Preoperative skin markings outlining the tumor and 3 mm excision margin.

Paso 2 — Step 2

Excision of the tumor was performed with a 3 mm margin, involving the conjunctiva, tarsal plate and lower eyelid skin.

Paso 3 — Step 3

The tarsoconjuctival flap was designed and elevated.

Referencias

Custer, Philip L. M.D., F.A.C.S.; Maamari, Robi N. M.D.. The Köllner Tarsoconjunctival Flap for Lower Eyelid Reconstruction: Historical Perspective and Surgical Outcomes of 140 Cases. Ophthalmic Plastic and Reconstructive Surgery 38(3):p 294-299, May/June 2022. | DOI: 10.1097/IOP.0000000000002099