The Ophthalmology Unit,  Universiti Malaysia Sarawak (UNIMAS), Kuching, Sarawak.

The Ophthalmology Department, Sarawak General Hospital, Kuching, Sarawak, East Malaysia.



Reversed Tenzel's flap for upper eyelid reconstruction

Photo by Dr. Yew and Professor Chua

The Tenzel's flap may also be used to reconstruct the upper eyelid defect. The patient had recurrent chalazion on the same site, biopsy confirmed sebaceous cell carcinoma. The lesion was excised with 5mm free margin. A reversed Tenzel's flap was fashioned to cover the defect which was about 40% of the upper eyelid. Biopsy showed the tumour was a moderately differentiated tumour and the margin of the excised specimen was free of tumours. Concurrent conjunctival biopsy did not show any pagetoid spread of the tumour.


Left upper eyelid sebaceous cell carcinoma.


Markings of pentagon excision and reversed Tenzel flap.


The tumour was excised with 5mm free margin. About 40% of the upper eyelid was excised.


A Tenzel flap consisting of myocutaneous tissue was fashioned. The lateral edge of the upper eyelid was free by performing lateral cantholysis.


The cut edges of the upper eyelid were first apposed.


The lateral canthal angle was formed using 6/0 Vicryl by suturing the myocutaneous tissue to the lateral margin of the lower eyelid.


The appearance of the eye 24 hours later.


Appearance of the eyelid at 24 hours. Lateral view.


The eye began to open at 7th day post-operative.


Lateral view of the eyelid at 7th day post-operative.



Atlas of Oculoplastic Surgery