A horizontal V-Y advancement lower eyelid flap: our experience performing a bilateral suspension to the periosteum.

BACKGROUND The authors were surprised to realize that the horizontal V-Y advancement flap of the lower eyelid is not even mentioned in the textbooks about eyelid repair, and they wanted to report their very positive experience with this subcutaneous pedicled flap. METHODS Between 2000 and 2006, 21 patients were operated on, 13 women and eight men, aged 37 to 98 years, with a mean age of 67.5 years. The diagnosis was basal cell carcinoma in 20 cases and melanoma in one case. The size of the defect ranged from 10 to 30 mm, with a mean of 20 mm. RESULTS All flaps survived and the aesthetic quality of the repair was excellent in 17 of 21 cases. Postoperative recovery was usually very fast. CONCLUSIONS The lower eyelid is covered with remarkably thin skin, and for the repair of defects, especially after removal of basal cell carcinomas, it is preferable to avoid using tissues coming from another facial area (e.g., forehead, nose, or cheek), which has a different thickness and texture, or a full-thickness skin graft, which can leave a patch-like appearance. The ideal is to use the adjacent eyelid skin. For many years, the authors have used a horizontal large V-Y advancement flap on a muscular pedicle for the repair of lower eyelid defects, mostly after basocellular carcinoma excision, with very satisfactory results and often nearly invisible repairs.