Temporoparietal Fascia Flap for Complex Eyelid Reconstruction: A Case Series and Literature Review

Abstract

Purpose: Large, complex eyelid defects involving all layers of the upper and/or lower eyelids still present a challenging problem. Temporoparietal fascia (TPF) flap can be used in some of these cases for reconstruction. The authors review the etiology, presentation, surgical technique, and results of this procedure and review the literature to date. Recommendations are made for optimizing surgical technique and guidelines for when to use the flap. Methods: The authors present a series of 4 cases of large eyelid defects reconstructed using the TPF flap. The etiology of these defects were: congenital, trauma, tumor and complication of maxillofacial surgery. Outcomes reviewed include functional and cosmetic results, and complications. Literature review of eyelid reconstruction using TPF flap is performed. Results: All patients achieved an acceptable cosmetic and functional outcome. There was resolution of both lagophthalmos and severe exposure keratopathy in all patients. Post-operative complication occurred in one patient and involved necrosis of the skin graft over the TPF flap. This was managed with a second skin graft several weeks later with satisfactory results. Conclusion: Trauma, tumors, congenital craniofacial anomalies and maxillofacial surgery for resection of sinus tumors can cause large eyelid defects. Small eyelid defects can be repaired with lid sharing procedures but for exceptionally large defects, these techniques become insufficient. TPF flap is an excellent option and can be used in these cases to achieve an acceptable cosmetic and functional outcome with preservation of the globe. TPF flap is a versatile option which can reconstruct a large eyelid defect with one procedure. Complications can be avoided with meticulous attention to detail. TPF flap is best suited for upper and/or lower eyelid defects which are categorized as Type III or Type IV.