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Periosteal Flap Safety, Effectiveness, and Aesthetic Quality in Posterior Lamella Reconstruction


Single-stage periosteal flap technique to treat full-thickness eyelid defects is safe, effective, and aesthetically acceptable, according to a study presented at the 2022 American College of Mohs Surgery Annual Meeting on May 12, 2022.

Shoshana R Blumenthal, MD, who is a dermatology resident the University of Minnesota at Minneapolis, and colleagues presented the clinical abstract of retrospective study on single-stage periosteal flap techniques at the 2022 American College of Mohs Surgery Annual Meeting.1

Two dermatologic surgeons performed eyelid reconstruction surgeries on 7 patients (5 men and 2 women; mean age 58 years). The procedures were performed at a single academic center between January 2017 and December 2021. Researchers reviewed patient demographics, operative notes, and follow-up notes; 2 cosmetic dermatologists examined follow-up photos for 6 of the 7 patients and used a visual analog scale.1 Blumenthal and colleagues reported that all tumors had been basal cell carcinoma and had a mean defect area of 6.03 cm2.

Researchers reported successful results, with all cases resulting in adequate surgical and cosmetic outcomes, Blumenthal noted during the presentation. The mean cosmetic score was 84.6 +/- 14.6, and there were no serious post-operative interventions or complications for patients.

Two of the patients had minor complications, and Blumenthal said during the presentation that this rate of less than 30% was comparable to those reported in ophthalmology series. Researchers reported that 1 female patient had “medial and lateral canthal webbing and slight scleral show which she opted to address conservatively, and one patient who experienced mild-to-moderate lagophthalmos and mild lower lid ectropion.”1 Blumenthal said at the presentation that there was “a correlation between defect size and complications, as well as defect size and a lower cosmetic score.”

Single-stage periosteal flap surgery can prevent patients from enduring traditional two-stage flaps that leave them with monocular vision, according to researchers.

"The horizontal component averaged 2.4 cm, which makes these cases particularly challenging," Blumenthal said. "Typically, this would have necessitated the 2-stage Hughes procedure."

“Additionally, unlike the classic lateral periosteal flap where the lateral canthal remnant is discarded, we demonstrated the utility of retaining the lateral tarsal remnant, releasing it with a full-thickness incision through mucosa, allowing its medialization, and thereby maximizing native tarsus and lashes,” Blumenthal and colleagues wrote.

Blumenthal said that Mohs surgeons can successfully and safely execute periosteal flaps to reconstruct large, full-thickness eyelid defects. “The potential benefits to these patients include fewer visits to a single provider, avoidance of general anesthesia, and preservation of monocular vision,” Blumenthal said at the conclusion of the presentation.


1. Blumenthal SR, Knabel D, Mori W, et al. Posterior lamella reconstruction by periosteal flap: a retrospective review. Presented at: 2022 American College of Mohs Surgery Annual Meeting; May 12-15, 2022, Philadelphia, Pennsylvania.

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