Double-bridge novel modification of Cutler–Beard flap for the reconstruction of full-thickness eyelid deformity

Introduction: Eyelid deformities can come from birth defects or other causes, and they often need full thickness reconstruction. The Cutler–Beard and Hughes techniques are still the best methods for repairing upper eyelid colobomas. However, there are not many choices available when the eyelid margin is still intact. Here, we report the clinical outcomes of a novel modification of the Cutler–Beard flap surgery in eyelid deformity for these difficult cases. Methods: Design: Retrospective study. Setting: Tertiary care hospital. Study Population: All patients who presented with significantly deficient full-thickness eyelid tissue and severe exposure keratopathy due to lagophthalmos in the last 6 months were studied. Intervention: Patients underwent double-bridge novel modification of the original Cutler–Beard surgery. Main Outcome Measures: The flap survival, correction of eyelid deformity, lagophthalmos, symptomatic improvement, and patient satisfaction were assessed retrospectively. The patients were also followed up for postoperative complications such as lid contour, margin abnormalities, residual lagophthalmos, lymphedema, and donor site complications. Results: Postoperatively, there was satisfactory coverage of the ocular surface in all patients. None of the patients had complications such as flap/bridge necrosis, infection, or excessive secondary contraction of the flap. Chronic lymphedema was observed in one patient due to severe periorbital fibrosis. Conclusion: The Cutler–Beard technique remains a cornerstone in the field of eyelid reconstruction due to its versatility and effectiveness in managing large full-thickness defects of the upper eyelid. The described novel modification adds a new indication to the armamentarium of the modified Cutler–Beard procedures for eyelid reconstruction.