Surgical outcome of a transposed lateral pendular flap for the reconstruction of medial and central lower lid defects

To evaluate the outcome and the degree of patient satisfaction with the reconstruction of full-thickness medial and central lower lid defects using a pendular flap of the remaining lateral part of the lower lid. Totally 20 patients with full thickness medial or central lower lid defects that could not be repaired by direct closure with or without cantholysis. A sliding full-thickness composite flap was created from the lateral part of the remaining lid to cover the defect. The posterior lamella of the induced lateral defect was repaired by either a periosteal flap alone or in combination with a free tarsal graft. Postoperative cosmetic and functional outcomes were evaluated. The mean age of the patients was 46.3±18.1y (20-70y). The defects ranged from 30%-80% of the lid width and resulted from the excision of lid tumors in 11 patients (55%) and from trauma in 9 (45%) patients. Postoperative complications included one case of lateral graft ectropion, 2 cases of lid retraction and 3 cases of marginal graft necrosis. Most of the patients had an acceptable final cosmetic outcome. Reconstruction of moderate-sized defects in the medial/central lower lid via a sliding flap yielded acceptable cosmetic and functional outcomes with high patient satisfaction. Large defects ≥50% of the horizontal length are at greater risk of complications. Reconstruction of medial defects by this technique was associated with a greater incidence of complications.