Vol 11-R2- Eyelid

SRPS • Volume 11 • Issue R2 • 2010
Medial Canthal Defects
Defects of the medial canthus resulting from
tumor excision are commonly encountered. They
are second in frequency to lower eyelid defects.
Proper repair of the defects is essential to restore
functionality to the eyelids and to achieve an
aesthetic result to eyelid reconstructive surgery. If
not appropriately addressed, the defects can lead
to life-long symptoms of tearing, foreign body
sensation, and poor cosmesis. Appropriateness
of the repair techniques depends on the type,
size, and depth of the defect and the health of
the surrounding tissues. Most importantly, a
combination of techniques might be necessary to
achieve the most desirable surgical outcome.
Glabellar Flaps
Glabellar flaps are commonly used to repair
medial canthal defects. When properly created,
the flaps can be effective. Turgut et al. 134 noted
that a traditional glabellar flap entails creating an
inverted V in the glabellar region, which is then
undermined and rotated to close the medial canthal
defect. Closure of the resultant wound converts
the inverted V to an inverted Y (Fig. 19). The size
of the flaps depends on the size of the defects
and can be enough to cover a full range of medial
canthal defects. Glabellar flaps offer advantages to
other flaps in the region. They are relatively simple
and can cover deep defects. They have sufficient
blood supply from the subdermal plexus and the
supratrochlear vessels. 134
One disadvantage to this technique is that
it tends to draw the eyebrows closer together.
Meadows and Manners 135 proposed a simple
modification. With the modified technique, the
glabellar flap is raised and rotated to cover the
defect, as described for the classic technique. The
redundant skin that results from transposing the
flap is then cut away and used to help close the
resultant Y-shaped wound, maintaining the normal
spacing of the eyebrows (Fig. 20).
Another modification of the traditional
glabellar flap that helps to avoid the “bulky”
appearance in the medial canthal region and the
34
drawn-together brows is the super thinned inferior
pedicled glabellar flap described by Emson and
Benlier. 136 With that technique, the glabellar
flap is raised, as classically described. 137,138 Once
the forehead wound superior to the eyebrow is
closed, the frontalis muscle and subcutaneous fat
are removed from the flap, leaving the axial blood
vessels. In their series of eight patients, Emson
and Benlier found that satisfactory cosmesis was
achieved in all, and the normal inter-brow distance
was maintained.
Figure 19. Glabellar V-Y flap. Illustration on the top depicts the
medial canthal defect with an inverted V originating from the
apex of the defect. Incision and rotation of the flap into the
defect result in an inverted Y as depicted in the illustration on
the bottom.