Case 02 2026: Tarsoconjuctival Flap for Eyelid Reconstruction

Keywords: Basal Cell Carcinoma, Skin Cancer, Eyelid Reconstruction, Tarsoconjuctival flap. Authors: Ajla Sabitovic, MD, Rikke Børthy Petersen, MD, Nanja Gotland Sundstrup, MD. Abstract This case describes the use of a tarsoconjuctival flap for reconstruction of the lower eyelid following excision of a basal cell carcinoma in a 76-year-old woman. Due to the tumor size, depth and location near the limbus of the eye, direct closure was not possible. The tarsoconjuctival flap was chosen as the preferred reconstructive approach because of its ability to reconstruct all layers of the eyelid. Postoperative follow-up at six months demonstrated satisfactory aesthetic and functional outcomes. Patient medical history A 76-year-old woman presented with a biopsy-confirmed nodular basal cell carcinoma involving the right lower eyelid. Tumor excision was performed in general anesthesia with 3 mm margin and intraoperative frozen-section control, confirming tumor free margins. Resection resulted in a full-thickness defect involving approximately 90% of the lower eyelid. Reconstruction was performed with a tarsoconjuctival flap for the posterior lamella and a Tripier flap from the upper eyelid for the anterior lamella. Before and After Patient examination Clinical examination revealed a 12 x 10 mm elevated ulcerating lesion involving the right lower eyelid, extending into conjunctiva and limbus. Pre-operative considerations The patient presented with a full-thickness defect of the lower eyelid involving conjunctiva and the inferior eyelid margin. Due to the tumor size and location direct closure was not possible. Reconstruction with a flap was therefore required to secure reconstruction of all layers of the lower eyelid to give the eyelid full support and thereby secure its function. 1 Step 1 Preoperative skin markings outlining the tumor and 3 mm excision margin. 2 Step 2 Excision of the tumor was performed with a 3 mm margin, involving the conjunctiva, tarsal plate and lower eyelid