The propeller Myocutaneous Flap of the upper eyelid. anatomical study and its clinical implication

The reconstruction of the upper eyelid and the periorbital region is a challenge for the surgeon. The aims of this reconstruction are to guarantee protection to the eyeball, maintain the visual field, and restore the function of the eyelid without damaging other anatomical structures. In this study, the authors describe the use of a propeller myocutaneous flap based on the small vertical branches of marginal, peripheral ed superficial arcade, for the reconstruction of the upper eyelid or periorbital region. The authors enrolled 3 patients (Caucasian), between 2018 and 2019, and subjected to reconstructive surgery with the propeller myocutaneous flap of the periorbital region at the Plastic Surgery Unit of the University of Messina. The vascularization of the flap was demonstrated through an anatomical study conducted on cadavers at the dissection laboratories of the University of Bordeaux 2. The authors have shown that the myocutaneous flap represents a valid alternative for loss of substance coverage and reconstruction of the upper eyelid or periorbital region, allowing the achievement of a good aesthetic and functional result. Patients were followed up at 3–6–12 months. No complications were reported (flap retraction, periocular region deformity, donor site morbidity). Furthermore, at the last visit, the scars were almost invisible. The use of the propeller myocutaneous flap of the upper eyelid is a valid reconstructive alternative to the standard techniques described so far for the reconstruction of the periorbital region. Reconstruction of large loss of substance (LOS) after the oncological resection is a difficult task. The upper eyelid is frequently interested by skin cancer. Medial and lateral canthus is often affected by basal cell and squamous cell carcinoma. Numerous techniques have been used to correct large upper eyelid defects.1–12 All reconstructive options require to create a skin flap from other regions,13–16 such as the cheek17 lower eyelid,2 forehead, etc9 to cover the LOS. In this work, the authors describe how to sculpt a new myocutaneous flap, using a novel technique with the satisfactory final results.