An 87-year-old woman referred to our Plastic Surgery Service due to pathology with a diagnosis of basal cell carcinoma in the left upper eyelid confirmed by paraffin biopsy.
It is programmed for surgical tumor resection covering 80% of the upper eyelid, resecting the tumor with free margins of 3 mm around and sending the sample for frozen biopsy.
The tarsal was exposed in the resulting defect; 90% of the skin of the parpado with orbicularpebral muscle was removed when it was infiltrated by the tumor.
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Pathological Anatomy indicated that the right and tarsal surgical limits were positive, so we had to remove these areas almost entirely.
Since we were forced to resect the upper eyelid practically in its entirety, there was a remnant of 10% on the left side in which a small portion of tarsals of 4 mm could be seen.
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We thought of tracing a dynamic flap, which at the time was designed to the temporal side based on the left temporal artery following a temporal course, thinking of achieving greater availability of tissue and bordering the scalp skin.
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We focused the flap including the orbicularis oris muscle of the eyelids and the remnant of the conjunctiva and tarsus and disarticulated from the external corner of the eye to advance it to the defect.
When performing this maneuver, the orbiculo-tarsal-conjunctival flap could be easily advanced and sutured with the remaining structures.
The conjunctiva of the flap was sutured with the remaining conjunctiva using vicryl 6-00, and then we proceeded to repair the tarsal muscle remnant of the flap with the muscle-aponeurotic complex suture of the eyebrow eye muscle using the eye flap.
Finally, we sutured the skin with nylon 6-00.
The external corner was repaired with 3-00 polypropylene thread.
