Aesthetic Correction of Severe Cicatricial Upper-Eyelid Ectropion with a Retrograde Postauricular Island Flap

Cicatricial ectropion of the upper eyelid is a serious problem because of the association with exposure keratitis and ulceration. Traditional surgical treatment usually requires skin grafts or local flaps depending on the severity of the defect. However, outcomes have usually been discouraging, especially in terms of cosmetic appearance. From February 2000 to March 2012, a total of 12 upper eyelids with severe cicatricial ectropion were treated with a retrograde postauricular island flap and were included in this study. Based on the pedicle of the parietal branch of the superficial temporal artery and its choke anastomoses to the posterior auricular artery, the retrograde postauricular island flap was harvested with a supra-auricular incision down to the non-hair-bearing side skin of the postauricular region. The flap was then transferred to the upper-lid lesion by passing it through a subcutaneous tunnel between the pedicle base and the upper-lid lesion. The donor site was directly closed by advancing the postauricular scalp flap into the sulcus. The largest flap was 6.5 x 3.5 cm(2). After 6-12 months of follow-up, flaps survived with good color, texture, and contour. The eyelids moved freely without recurrence of ectropion. The donor site had an inconspicuous scar. No major complications occurred. The retrograde postauricular island flap can be a safe, simple, and effective procedure for aesthetic correction of severe cicatricial upper-eyelid ectropion with few complications and little donor-site morbidity. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.