Reconstructive options for periocular defects

Reconstruction of the periorbital area following skin cancer excision requires a thorough knowledge of orbital anatomy and eyelid function. Reconstructive procedures should maintain the function of periorbital structures while attempting to achieve optimal cosmesis. Generally, eyelid reconstruction can be considered in terms of the thickness and overall size of the defect. Both the anterior and posterior lamella should be restored, and at least one of these layers needs to be vascularized. The integrity of the canthal tendons should also be addressed. If severed, the tendons should be attached to bony landmarks in order to recreate the proper curvature of the eyelid against the globe. Finally, defects involving the lacrimal system should be assessed and properly reconstituted.