Abstract
The Hughes tarsoconjunctival flap provides a means of reconstructing posterior lamellar defects of the lower eyelid. This lid sharing procedure allows reconstruction of lower eyelid margin defects encompassing as much as 90 % of the eyelid. The tarsoconjunctival flap entails advancing a flap of upper eyelid conjunctiva and tarsus down to the lower eyelid. The rectangular flap is sized according to the size of the defect. A portion of the upper lid tarsal plate and conjunctiva (approximately 4 mm in height) is left intact to maintain upper eyelid stability.
The anterior lamellar defect is reconstructed during the same operation with a local myocutaneous flap or full thickness skin graft. The tarsoconjunctival flap requires a second stage procedure 4–6 weeks later to divide the flap. In the interim, the eyelid is partially closed which may limit vision, particularly if this is the patient’s better (or only) seeing eye.