Reconstruction of the Eyelids

The eyelid is composed of the anterior and posterior lamellae. Repair of both must be undertaken during reconstruction to optimize eyelid function, globe protection, and cosmesis. The chosen reconstructive method is dependent upon the state of the eyelid margin, the depth/thickness of the defect, and the size of the wound. The key reconstructive principle is the provision of an inherent blood supply for either the anterior or posterior lamella (pedicle flap). An inherent vascular supply ensures tissue survival and an optimum surgical outcome for the patient. Additionally, reconstruction should provide maximal horizontal stabilization and minimal vertical tension. The lateral canthal area must be fixated properly, and an epithelialized internal surface must face the globe. Finally, the levator must be identified and addressed appropriately during upper eyelid reconstruction to ensure proper eyelid opening and function.