Abstract
Patients should be evaluated and deemed appropriate for such surgical intervention. Smaller eyelid defects can be repaired using direct closure with or without canthotomy and cantholysis. Larger defects may require more elaborate surgical techniques such a Hughes tarsoconjunctival flap with an independently rotated myocutaneous flap for anterior lamellar reconstruction. Patients with moderate-sized upper or lower lid defects are ideal candidates for this procedure, though some surgeons extend the application to significantly larger defects, particularly in those who would not be good candidates for an eyelid sharing procedure (monocular patients and children at risk of amblyopia). An additional advantage of the Tenzel flap is that any remaining temporal eyelashes are transposed centrally, minimizing the potential cosmetic penalty of surgical madarosis. The choice of technique for eyelid reconstruction should be discussed with the patient once the size of the defect is known 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 as well as about any alternatives.