Complex techniques of eyelid reconstruction following extensive basal cell carcinoma resection

Abstract

Basal cell carcinoma (BCC) is one of the most common malignant tumors overall and even the most common malignant tumors in ophthalmology. In most cases, surgical resection followed by an ophthalmoplastic reconstruction is the current gold standard for the treatment of periocular BCC. Histopathologic analysis can be performed both as a frozen section examination, Mohs micrographic surgery, or as a rapid embedding analysis, depending on the surgeon’s preference or the in-house standard. A histopathologic workup is essential not only for confirming the diagnosis and determining resection status but especially for identifying infiltrating growing subtypes, as this also influences postoperative follow-up and prognosis. A wide range of various reconstruction methods allow individualized defect coverage with mostly good cosmetically and functionally results. The basic principle is to restore the anatomy with an anterior and posterior eyelid lamella. The selection of the appropriate technique depends not only on the vertical and horizontal defect size, defect localization, or potential eyelid edge involvement but also significantly on the patient’s age, available tissue (e.g., skin), the patient’s preference, and especially the surgeon’s experience. For smaller, partial, or penetrating defects, direct wound closure can be performed. However, for greater defects more complex reconstruction techniques including Tenzel’s rotational plasty, Hughes flap, CutlerBeard plastic, Mustardé lid Switch flap, tarsomarginal grafts according to Huebner, or V-Y glabella flap are necessary, dependently on the size and the location of the defect. However, in advanced findings with infiltration of the orbit, orbital exenteration is unavoidable in some cases. Postoperative regular follow-up is essential to identify potential complications in an early stage.