Total Lower Eyelid Reconstruction With Auricular Cartilage-Perichondrium Graft and Upper Eyelid Rotation Flap

Reconstruction of large full-thickness lower eyelid defects remains a complex challenge in oculoplastic surgery because restoration of both functional integrity and aesthetic appearance is required. Successful reconstruction depends on adequate replacement of the posterior lamella to provide structural support and reconstruction of the anterior lamella to ensure appropriate coverage and mobility. The study presents a sample of 10 patients who presented with a basocellular carcinoma of the lower lid. A full-thickness resection with wide margins was performed and medial, lateral, and deep margins were subjected to extemporaneous histologic examination. In all 10 patients, to attain complete resection with 3 mm negative margins, following NCCN recommendations, a full-thickness total lower eyelid resection was performed. Reconstruction of the posterior lamella was performed using an auricular cartilage-perichondrium graft harvested from the concha. The perichondral surface was oriented toward the ocular surface to promote epithelialization and avoid friction on the cornea. The anterior lamella was reconstructed using a rotation flap from the upper eyelid. The procedure achieved satisfactory eyelid stability, adequate globe protection, and good cosmetic outcome. At 1-year follow-up, the reconstructed eyelid maintained good structural integrity without significant complications. This combined technique represents a reliable and effective option for reconstruction of extensive lower eyelid defects.