Surgical management of lower-lid basal cell carcinoma involving the medial canthus: a modification of the Mustarde cheek rotation flap.

The Mustarde cheek rotation flap has proved to be an extremely successful and reliable technique for repairing large defects of the lower lid. However, when a stump of normal, lash-bearing lid margin remains on the advancing edge of the flap, it does not seem appropriate to insert it into a defect that extends more medially than the position of the lower punctum. The lid margin must either be sacrificed or tissue brought in from the medial side to meet it. To resolve this problem, we have devised a modification, which involves utilizing the triangle of tissue lying below the defect to fill the gap medial to the position of the punctum. The maneuver has proved successful and has now been used on two occasions with satisfactory cosmetic and functional results. In this original descriptions of the cheek rotation flap, Mustarde sacrificed the triangle of skin below the excision defect. However, if a triangular portion is saved, based on the upper part of the advancing edge of the flap, this may be used to fill a medial defect, obviating the need to import tissue from elsewhere.