Reverse modified hughes procedure for upper eyelid reconstruction

Purpose: To describe the outcome of the reverse modified Hughes procedure for the reconstruction of extensive full-thickness defects of the upper eyelid. Methods: Seventeen cases of full-thickness extensive upper eyelid defects were reconstructed using the reverse modified Hughes procedure. Extensive defects were characterized as those with a width of 80% or more of the eyelid after tumor excision. Posterior lamella reconstruction was achieved using a pedicled tarsoconjunctival flap from the donor lower eyelid. For anterior lamella reconstruction, the orbicularis oculi muscle superior to the defect was mobilized and transposed over the tarsoconjunctival flap. A cutaneous advancement flap using redundant skin adjacent to the defect or a free postauricular skin graft in cases of insufficient lax skin was used to cover the orbicularis oculi muscle flap. The tarsoconjunctival pedicle was divided 3 to 8 weeks after the primary operation. Results: Seventeen patients from 40 to 81 years of age were included in the study. The underlying diagnoses included sebaceous gland carcinoma (13), squamous cell carcinoma (3), and Merkel cell carcinoma (1). Follow-up of 6 to 80 months revealed no cases of flap ischemia or identifiable necrosis after division. The functional and aesthetic outcomes were generally satisfactory throughout follow-up. Postoperative complications included epithelial keratopathy (4), lagophthalmos (3), upper eyelid entropion (2), granuloma formation (2), and lower eyelid entropion (1). Conclusions: The reverse modified Hughes procedure with orbicularis muscle mobilization was successful in repairing extensive full-thickness upper eyelid defects greater than 80% of the eyelid width. The mobilization of the orbicularis oculi muscle, with its robust vascular supply, enhances the viability and cosmetic appearance of the reconstructed eyelid.