Severe ectropion: repair with a modified Tripier flap.

Classical techniques, such as wedge resection, are well suited for mild cases of lower lid ectropion, but they often fail to cure severe cases. The reason these techniques often fail is because they address only the laxity and elongation of the ectropic lid, not the root cause. In nearly every case of severe ectropion, the root cause is importance of the pretarsal orbicularis muscle; i.e., there is inadequate muscle support for the pretarsal lower eyelid. A bipedicled musculocutaneous flap, transferred from the upper lid, was used to treat nine cases of severe lower eyelid ectropion. Eight patients had a good/excellent result. Four patients had electromyographic studies in the late postoperative period, without a single instance of even mild denervation. In cases of severe ectropion, this flap is an effective replacement for the missing skin and impotent muscle. It uses the often discarded blepharoplasty tissue, which has a perfect color and texture match. A single anatomic unit is rebuilt, transferring a strong new muscle strap with ideal supporting vectors and leaving scars in natural creases. This "blepharoplasty flap" may prove useful in other types of eyelid reconstruction.