Introduction
Reconstruction of eyelid is always a challenging
issue. Particularly when the defect size is large
(more than 50% ) and associated with periocular
tissue loss. There are several requirements for an
eyelid reconstruction to be considered "aesthetic."
Both lids have to be in proper position, with
normal palpebral fissure width and height. The
eyelid margin should be distinct from the
preseptal segment. Tissues must be thin to blend
seamlessly with local skin. Finally, the canthal
angles must be sharp and crisp1. Sometimes upper
and lower both lids need to be reconstructed. That
is the most critical issue. Surgeon should be aware
of ocular healthy environment, that should not be
compromised. Corneal transparency and tear
distribution should not be hampered.
Lagophthalmos is a big problem. If bells
phenomenon is good to cover night time, a little
amount of lagophthalmos may be allowed with
ocular lubricants. Age, location and amount of
defect are the main factors before definite
procedure. Conjunctival surface and corneal
epithelium should be moist by undisturbed tear
film. Sometimes conjunctival reflection may used
to cover little portion of newly formed
reconstructed surface. If it is inadequate then
mucous membrane graft or amniotic membrane
may be considered. Usually full thickness skin
graft is insufficient to cover function of both lamella when it is removed or lost after trauma. In
this situation flap technique is very effective. In
ophthalmic plastic and reconstructive procedure
local and regional flap is used. Proper cosmesis is
always a vital issue. Donor site morbidity should
be minimal.
Materials and Methods
The prospective interventional study was
conducted in the Orbit & Oculoplasty department
of Lions Eye Institute and Hospital, Agargoan,
Dhaka, during the period from 01.07.2022 to
30.06.2023. Total 16 patients with variable degree
of large periocular defect ( post surgical and post
traumatic ) was taken for this study. All patients
underwent reconstructive surgery under general
anaesthesia. Lid and peri-ocular defect repaired
with skin graft was not taken for this study. Small
defect closure, surface repair with direct closure
were not enrolled. Two and more flaps and
composite graft with several flaps are included.
Inclusion criteria were large(>50%) lid and
periocular defect which was not recoverable with
one surgical technique. Exclusion criteria were
small defect, one lamellar defect, only surface
repair, direct closure. All the study subjects were
informed about the study, were confirmed about
the privacy and taken consent about the study and
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