LARGE PERIOCULAR DEFECTS RECONSTRUCTION WITH AXIAL AND RANDOM PATTERN FLAPS. INDICATIONS, TECHNIQUE DESCRIPTION AND FOLLOW-UP ON OCCASION OF 4 CASES

​INTRODUCTION: Large periocular defects have always been a reconstructive challenge in terms of viability, cosmesis and functionality. Their vicinity with important anatomical structures makes reconstruction difficult to plan and the surgeon should take into account several alternatives. AIM: Our aim is the presentation of techniques performed on our department patients. Four intendedly different cases treated with respective flaps are documented preoperatively, postoperatively and in the follow-up period. MATERIAL – METHODS: 4 Patients (2 male and 2 female) with cutaneous malignancies concerning: the inner canthal ligament area (1), the nasal flank and lower eyelid (1) and the lower tarsal plate (2). 1 inferiorly based advancement nasolabial flap, 2 Mustardé flaps and 1 Tenzel flap were performed. The mean age of the patients was 85,75 y.o. (range from 77 to 96). RESULTS: All four patients had disease-free margins of excision and no recurrence at all. We avoided composite approaches with concern to their age and general condition. No complications were mentioned (including necrosis of the flap, wound dehiscence or infection). The esthetic result is judged fair (1 patient), good (1 patient), very good (2 patients). In the follow-up period, one patient presented mild epiphora and another mild corneal exposure. One patient being planned to undergo a differed correction postponed his treatment. CONCLUSION: Meticulously designed traditional flaps such as V-Y advancement flap, Mustardé flap and Tenzel flap can offer an acceptable outcome balanced between functionality and cosmetic result on the one hand and lessening complications on the other.