ATLANTA A novel anchored rotation flap for infraorbital cheek reconstruction allows full defect repair without causing lower-lid ectropion, Dr. Kord Honda said at the joint annual meeting of the American Society for Dermatologic Surgery and the American College of Mohs Micrographic Surgery and Cutaneous Oncology.
The technique involves the use of an anchoring suture to allow an inferiorly based rotation flap for horizontal defects of the midpupillary and medial infraorbital cheek. The suture allows horizontal redirection of the flap tension vectors, which helps prevent ectropion, explained Dr. Honda, a dermatology resident at the University of Washington, Seattle.
In four patients with defects ranging in size from 1.4 by 2.9 cm to 2.4 by 3.4 cm, outcomes at up to 3 months were excellent, with no evidence of lower-lid ectropion, he said.
The long axes of the defects in all four patients were horizontally oriented: Two were centered on the midpupillary line, and two were located medially.
The patients first underwent Mohs surgery for complete skin cancer removal; then the edges of the defect were made perpendicular. An incision was made to the midsubcutaneous fat at a 90-degree angle along the nasofacial sulcus and extended into the melolabial fold if necessary.
The flap, designed to rotate tissue from the inferior aspect of the defect, was undermined with sharp dissection in the midsubcutaneus fat. The anchoring suture was placed first and served as the key stitch. This suture was placed from the superior medial portion of the flap into the periosteum of the superior nasal sidewall or medial maxilla, Dr. Honda reported.
Testing for ectropion and eclabium was performed. The wound edges were approximated with a running 50 or 60 nylon suture with tension placed horizontally to prevent ectropion.
This anchored rotation flap is a one-stage procedure that preserves the eyelid margin and is ideal for horizontally oriented defects, he said.