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Cutler-Beard's technique for large upper eyelid defect

Photo by Dr. Yew and Professor Chua

A 45 year-old woman from a village presented with recurrent left upper eyelid chalazion. Recently she noticed a sudden increase in the upper eyelid lesion and again consulted a local ophthalmologist. Biopsy revealed sebaceous cell carcinoma. Examination showed a rubbery left upper eyelid mass obstructing the visual axia but the vision was normal. There was no evidence of lymphadenopathy. A near total upper eyelid excision was performed and the lesion was sent for analysis to ascertain clearance. Pinch biopsy of the conjunctiva was also performed for any pagetoid spread. The upper eyelid was then reconstructed using the Cutler-Beard's technique. The eyelid will be reopened in 6 weeks time when the patient returned from her village.

 

Left upper eyelid lesion obstructing the visual axis.   Marking of the tumour for excision and reconstruction.   Excision of the tumour.   Near total excision of the upper eyelid. Tumour sent for histology. The lid was marked with sutures to denote the orientation. The short suture indicate medial aspect of the lid margin and the long suture the lateral aspect.   The other view of the excised tumour.   Lid guard coated with chloramphenicol ointment is used to fashion full thickness flap from the lower lid. Calipre is used to make a horizontal incision 5 mm below the lid margin to prevent necrosis of the bridge.   Scissors were used to complete the horizontal incision.     An inverted U-shaped is formed by performing two vertical incisions. The different layers of the flap were idenitified. The two pairs of forceps were holding the inferior tarsal conjunctiva. The flap was pulled through the bridge to be connected to the upper eyelid.     The flap was sutured in layers beginning with the conjunctiva.   This was followed by suturing the levator aponeurosis to the orbicularis oculi of the lower eyelid.   Both the conjunctiva and levator aponeurosis were now sutured to the lower flap.   The skin was sutured together at the end.   24 hours post-reconstruction.

Atlas of Oculoplastic Surgery