Split lamellae switch flap for upper eyelid reconstruction.

A new concept for elevating a switch flap from the lower eyelid and then closing the defect is advocated. This flap is composed of two different-sized lamellae, the horizontally extended anterior lamella and the conventional wedge-shaped posterior lamella and lid margin. The donor's defect is to be closed with each lamella; the posterior lamella is horizontally advanced and directly closed with the aid of lateral canthotomy and cantholysis, and the anterior lamella is closed directly by extending the incision laterally to the temporal region and advancing the skin superolaterally. The switch flap can be applied to previously unindicated, nontypical upper eyelid defects by means of the split lamella concept and procedure. An illustrative case is presented.