Functional Reconstruction of Lower Eyelid Using Paramedian Forehead Flap Combined with Frontalis Muscle and Periosteum

Abstract

Both cosmetic and functional aspects are important in reconstructing the lower eyelid tissue defects. In this case report, we describe a two-stage reconstruction of a skin defect, including the orbicularis oculi muscle, after resection of a basal cell carcinoma using a paramedian forehead flap combined with the frontalis muscle and periosteum. In the first stage, the paramedian forehead flap, including the frontalis muscle and periosteum, was elevated, the periosteal flap was fixed to the outer orbital periosteum to lift the lower eyelid, and the skin flap, including the frontalis muscle, was sutured to the defect. In the second stage, the flap was divided and the frontalis muscle flap was sutured to the medial palpebral ligament. Electromyography at 1 year postoperatively confirmed neurotization of the transferred muscle, and at 6 months, voluntary contraction of the transferred muscle was observed during eyelid closure. These results suggest that a paramedian flap combined with the frontalis muscle and periosteum is a useful option for reconstructing horizontal skin defects involving the orbicularis oculi muscle.

Keywords

forehead flap - lower eyelid - neurotization

Ethical Approval

Exemption from approval.

Patient Consent

Patient provided written consent for publication.

Authors' Contributions

All authors (1) made substantial contributions to the study concept, and data analysis and interpretation; (2) drafted the manuscript or revised it critically for important intellectual content; (3) approved the final version of the manuscript to be published; and (4) agreed to be accountable for all aspects of the work.

Data Availability

All data pertaining to this paper can be made available upon reasonable request to the corresponding author.

Publication History

Received: 19 March 2024

Accepted: 17 January 2025

Accepted Manuscript online:
22 January 2025

Article published online:
15 May 2025

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