The use of a periosteal strip for eyelid reconstruction.

Strips of periosteum from the zygoma were used to reconstruct very extensive lateral canthal and temporal eyelid defects in 11 patients. The strips were reflected nasally, sutured to residual tarsal stumps, and covered anteriorly with myocutaneous flaps. After a minimum follow up of one year, cosmesis was excellent in five patients, satisfactory in five, and poor in one. Minor complications related to this procedure included ectropion and low lateral contour (one patient each), blunting of the lateral canthal angle (three patients), eyelid notching and dehiscence (one patient each), and symblepharon formation (one patient). However, only one patient had a complication that was significant enough to require a second surgery. This technique allows for one-stage reconstruction, an open palpebral fissure, and the ability to reconstruct extensive loss of the temporal portion of two adjacent eyelids when sharing techniques are not possible.