Upper eyelid rotation flap for reconstruction of medial canthal defects.

M edial canthal defects resulting from cancer resection after Mohs micrographic surgery present challenging reconstruction dilemmas. In fact, medial canthal reconstruction has been controversial because of the time-honored method of second-intention healing in wound management of this area. Yet, small flaps and grafts for repair of cutaneous medial canthal defects may result in a quicker healing process with excellent cosmetic results. The main difficulties of reconstruction of the medial canthal region are the lack of local availability of similar thin eyelid skin, and the concavity of the defect to be repaired. The area of the medial canthus includes the free tissue margins of the upper and lower eyelids, the bony attachments of the medial canthal tendon, the lacrimal puncta, and arteriovenous and neural bundles that supply and innervate the region. The literature describes a multitude of surgically complex and intricate reconstruction methods including eyelid myocutaneous transposition flaps, glabellar flaps, cheek flaps, V-Y advancement flaps, and skin grafts for repair of defects of the medial canthus. Although these reconstructive options represent tested and widely used choices for medial canthal restoration, they are limited in that these techniques often provide a less than ideal color or texture match, provide tissue that is either too thick or too thin, or place incisions that cross aesthetic units and boundaries. We describe a novel flap that is conceptually simple to design and execute for the repair of medial