Multiple aesthetic unit flaps for medial canthal reconstruction

The medial canthal region includes several individual aesthetic units that differ in skin quality and thickness, contour, and associated landmarks. Basal cell carcinomas commonly involve the medial canthal region and extend without respecting the boundaries between units. Reconstruction of tumor-free defects is often complicated by web formation across the medial canthal concavity. To avoid this complication, we evaluate each defect according to the anatomic units involved and develop individual flaps from each component area, anchoring each flap to the medial canthal tendon or associated deep fibrous tissue. This system has been used in 58 cases with excellent results. It allows flexibility for reconstructing the many diverse defects that oculoplastic surgeons encounter and helps to minimize postoperative deformity.