[Role of Köllner-Hughes tarsoconjunctival flap in the reconstruction of large eyelid defects].

Purpose: To evaluate the aesthetic and functional results of the Köllner-Hughes tarsoconjonctival flap technique for large defects of over three-quarter of the lower eyelid.

Patients And Methods: A retrospective descriptive study of a series of 15 patients treated between January 2013 and December 2015. We included all patients who underwent reconstructive surgery for a tumor involving more than three-quarter of the lower eyelid and sparing the canthi. Reconstruction of the lower eyelid defect was performed using Köllner-Hughes technique.

Results: The mean age of our patients was 65.7±8 years. The sex ratio was 1.5 with male predominance. All patients had well-differentiated basal cell carcinoma of the lower eyelid. The average size of the eyelid defect induced by the surgery was 18±4mm. Release of the tarsoconjonctival flap was performed after a period of 8 to 10 weeks after the reconstructive surgery. After a mean follow-up of 12±6 months, the aesthetic and functional results were satisfactory in 86.7% of cases especially in terms of eyelid closure and protection of the ocular surface. Complications included erythema of the newly formed free edge in 26.7% of cases, keratinization and hypertrophy of the free edge in 20% of cases, the deformation of the upper free edge with an associated entropion in 20% of cases and lower eyelid retraction in 6.67% of cases. Ocular surface disease such assuperficial punctate keratitis or dry eye was found in 13.4% of cases.

Discussion: Several authors have chosen the Köllner-Hughes technique to treat increasingly wide eyelid defects with very satisfactory results. Eyelid reconstruction with the Köllner and Hughes technique is a very attractive procedure because it offers several advantages. It is a quick and easy technique that covers wide defects over three-quarter of the lower eyelid well with very satisfactory cosmetic results and without significantly increasing morbidity at the donor site. In combination with additional procedures, this technique can totally reconstruct the lower eyelid. Despite all its benefits, the Köllner-Hughes tarsoconjonctival flap has some minor drawbacks, such as the need for two surgeries spaced a few weeks apart to open the palpebral fissure; therefore it is contraindicated for one-eyed patients and children because of the risk of amblyopia.

Conclusion: The tarsoconjonctival flap as initially described by Köllner and Hughes was indicated in the reconstruction of moderate and medium-sized defects of the lower eyelid. In our practice, we can extend the indications of this technique to much larger defects than three-quarter of the lower eyelid, while ensuring satisfactory aesthetic results and minimal complications.