The dehiscent Hughes flap: outcomes and implications.

PURPOSE The modified Hughes procedure is used to reconstruct full-thickness lower eyelid defects. A tarsoconjunctival flap from the upper eyelid replaces the posterior lamella, whereas a skin graft, a skin flap, or a skin-muscle flap restores the anterior lamella. The conjunctival pedicle from the upper eyelid is divided after vascularization of the reconstructed lower eyelid is judged to be adequate (traditionally, at least 3 weeks postoperatively). This study reviews the outcomes of patients in whom the conjunctival flap prematurely dehisced. METHODS Eight patients were identified during a 15-year interval. The posterior lamellar defects ranged in size from 13 to 30 mm horizontally and 5 to 8 mm vertically. The average age at the time of eyelid reconstruction was 72 years (range, 60-84 years). Flap dehiscence, resulting in each case from accidental trauma, occurred between 1 and 11 days postoperatively. Surgical repair of the dehiscence was unsuccessfully attempted in one case; otherwise, the eyelids were permitted to heal spontaneously with the application of erythromycin ophthalmic ointment as the sole therapy. RESULTS Although the result was satisfactory in each case, one patient, who had dry eyes from Sjögren's syndrome, required secondary surgery to treat mild lagophthalmos and lower eyelid retraction. Follow-up ranged from 3 to 122 months (median, 6.5 months). CONCLUSIONS The ultimate functional and aesthetic outcomes after premature, traumatic dehiscence of a Hughes flap were surprisingly good, suggesting that elective division of the conjunctival pedicle in routine cases can be performed relatively soon after the primary reconstructive procedure.