Vertical-to-Horizontal Rotational Myocutaneous Flap for Repairing Cicatricial Lower Lid Ectropion: A Novel Surgical Technique

Figure 1

(a) Cicatricial ectropion of the right lower eyelid in an 83-year-old man (case ). (b) Two vertical lines (12 to 15 mm) that were 8- to 12-mm wide were marked on the lateral third of the lower eyelid. The distance depended on the severity of the anterior lamella deficiency and on horizontal lid laxity. A 15- to 18-mm line was drawn medially and slightly upward along the base of the vertical flap. (c) After a lid plate or guard was inserted, two parallel vertical incisions were made using a number 15 scalpel blade. (d) A partial-thickness, horizontal relaxing incision was made medially along the base of the vertical pedicle. With Stevens scissors, the dissection was extended inferiorly to release any scar contracture of the lower lid. (e) and (f) A vertical myocutaneous flap was created by removing the posterior lamella and the lid margin (cilia portion) of the vertical pedicle and then rotated horizontally and sutured with 6-0 silk. (g) The lid margins of the two vertical incisions were approximated with three stitches of 6-0 silk, and the tarsus plate and preseptal and pretarsal orbicularis were sutured with 6-0 catgut. (h) The vertical myocutaneous flap was rotated horizontally and sutured with 6-0 silk.

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