Abstract
Patients should be evaluated and deemed appropriate for such surgical intervention. Patients with large margin-involving lower lid defects are candidates for this procedure. The choice of technique for eyelid reconstruction should be discussed with the patient and the appropriate procedure tailored to the individual patient’s needs and anatomy. Patients should be educated about the risks and benefits of the procedure and those pertaining to any appropriate alternatives. Hughes flaps result in functional closure of the eye for 3–6 weeks before a second stage is performed to sever the conjunctival flap. From a reconstructive perspective it is advantageous to have independent blood supplies to both the anterior and posterior eyelid lamella, but temporary closure may not be appropriate for monocular patients or children at risk of amblyopia. In such cases, consideration should be given to a Tenzel flap, a sliding tarsoconjunctival flap for smaller horizontal defects, or to a free tarsal graft for larger defects.