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Perfusion Monitoring Shows Minimal Blood Flow From the Flap Pedicle to the Tarsoconjunctival Flap

Tenland, Kajsa M.D.*; Memarzadeh, Khashayar M.D.*; Berggren, Johanna M.D.*; Nguyen, Cu Dinh M.D.*; Dahlstrand, Ulf M.D.*; Hult, Jenny M.D.*; Engelsberg, Karl M.D., Ph.D.*; Lindstedt, Sandra M.D., Ph.D.; Sheikh, Rafi M.D.*; Malmsjö, Malin M.D., Ph.D.*

Ophthalmic Plastic & Reconstructive Surgery: July/August 2019 - Volume 35 - Issue 4 - p 346–349
doi: 10.1097/IOP.0000000000001250
Original Investigations

Background: A previous study in pigs has shown that the pedicle of the tarsoconjunctival flap does not appear to have adequate blood perfusion. The aim of this study was to monitor perfusion in tarsoconjunctival flaps in patients with large lower eyelid defects resulting from tumor surgery.

Methods: The modified Hughes procedure was performed in 13 patients. Blood perfusion was monitored using laser Doppler velocimetry and laser speckle-contrast imaging.

Results: Blood flow decreased gradually from the pedicle base to the end of the flap and was 19% at the flap base, 11% in the middle of the flap, and 4% in the distal end of the flap. The flaps survived, and there was no tissue necrosis.

Conclusions: Tarsoconjunctival tissue survival does not seem to be dependent on a conjunctival flap. Free tarsoconjunctival grafts or composite grafts might be considered as viable alternatives in reconstruction of major eyelid defects.

The tarsoconjuntival flap appear not to contribute to the blood perfusion of the tarsoconjunctival grafts in 11 patients with excellent clinical outcome and survival of all grafts.

*Department of Clinical Sciences Lund, Ophthalmology

Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden

Accepted for publication August 29, 2018.

This study was supported by the Swedish Government Grant for Clinical Research (ALF), the European Union’s Horizon 2020 program for Research and Innovation, Skåne University Hospital (SUS) Research Grants, Skåne County Council Research Grants, Crown Princess Margaret’s Foundation (KMA), the Foundation for the Visually Impaired in the County of Malmöhus, The Nordmark Foundation for Eye Diseases at Skåne University Hospital, the Diabetes Society of South-West Skåne, and the Swedish Eye Foundation.

The authors have no financial or conflicts of interest to disclose.

Address correspondence and reprint requests to Malin Malmsjö, M.D., Ph.D., Head of Department of Ophthalmology, Ögonklinik A, admin, 2nd Floor, Kioskgatan 1B, Skåne University Hospital, SE-221 85 Lund, Sweden. E-mail:

© 2019 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.