Bridge flap: Cutler beard flap

The Cutler Beard bridge flap procedure can be used to reconstruct upper eyelid defects up to 90 % in size. The bridge flap is a two stage lid sharing procedure. In the first stage, a full thickness pedicle is transposed from the lower eyelid to the upper eyelid. The second stage entails dividing the pedicle and trimming excess tissue as needed. Tissue transferred during the first stage includes skin, muscle, and conjunctiva. The tarsus is not transferred and as a result, the lid margin may be unstable and predisposed to entropion. This can be addressed by placement of a posterior lamellar graft. After completion of the first stage of surgery, the eyelids are completely shut. This is an important consideration when operating on a patient in which the operative eye is their better (or only) seeing eye.