CASE REPORT Upper eyelid defect by dog bite reconstructed by an ipsilateral advanced tarsoconjunctival flap with skin graft Sameh Saad & Yasuhiro Takahashi & Lucy A. Goold & Hirohiko Kakizaki Received: 23 August 2009 / Accepted: 29 August 2010 / Published online: 17 September 2010 # Springer-Verlag 2010 Abstract A technique for reconstruction of a traumatic upper-eyelid marginal defect utilizing a local tarsoconjunc- tival advancement flap with a skin graft is presented. A 22-year-old woman was bitten by a dog, resulting in a full- thickness loss of approximately the central half of her left upper eyelid. Debridement was performed under topical anaesthesia followed by one-stage upper eyelid reconstruc- tion. The residual tarsal plate was used as a tarsoconjunc- tival advancement flap to reconstruct the posterior lamella of the defect. Skin from the posterior aspect of the left ear was grafted onto the reconstructed posterior lamella with two setting tarsorrhaphy sutures. One month postoperatively, the patient had an excellent cosmetic result with appropriate upper eyelid height and curvature, although cilia were not transplanted. The technique described offers a one-stage procedure with a simple surgical method providing on appropriate cosmetic and functional result. Keywords Reconstruction . Upper-eyelid marginal defect . Tarsoconjunctival advancement flap . Skin graft . Dog bite Introduction Both functional and cosmetic correction improvement is required in the reconstruction of upper eyelid defects [1]. The creation of a mobile upper eyelid which is able to achieve complete eyelid closure, with appropriate height and contour, is necessary to provide a physiologically well- adapted eyelid. The most essential cosmetic consideration is the construction of an eyelid similar to the unaffected eyelid in contour, colour and flap thickness [2]. Whilst several surgical options are available for eyelid reconstruc- tion [3], these depend on the extent of involvement of the anterior and posterior lamellae. Most of the upper-eyelid reconstruction techniques inevitably require sacrifice of the lower eyelid and a two- stage operation [4]. In addition, the donor site morbidity is a consideration and may require occlusion of the visual axis for weeks to months, increasing recovery time and posing difficulties for patients who are monocular or young enough to be at risk for deprivation amblyopia [5]. We present a case of a full-thickness upper eyelid defect resulting from a dog bite. A one-stage reconstruction using an ipsilateral advanced tarsoconjunctival flap with a skin graft was performed. Case report The left upper eyelid of a 22-year-old female was bitten by a dog and partially lost (Fig. 1a). The patient was immediately admitted to an emergency hospital and was treated with topical antibiotic ointment only and advised to return for review in 2 weeks. As she could not close her The authors have no financial support and no financial interest related to this manuscript. S. Saad : Y. Takahashi : H. Kakizaki (*) Department of Ophthalmology, Aichi Medical University, Nagakute, Aichi 480-1195, Japan e-mail: cosme@d1.dion.ne.jp L. A. Goold South Australian Institute of Ophthalmology and Discipline of Ophthalmology and Visual Sciences, University of Adelaide, Adelaide, South Australia, Australia Eur J Plast Surg (2012) 35:109–111 DOI 10.1007/s00238-010-0509-2