Journal of Shandong University (Health Sciences) ›› 2025, Vol. 63 ›› Issue (7): 37-43.doi: 10.6040/j.issn.1671-7554.0.2024.0606

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Clinical efficacy of modified Hughes flap for reconstruction of large full-thickness defects of the lower eyelid

ZHANG Lei, PAN Ye, LI Jiagen, ZHAO Hong   

  1. Department of Orbital and Oculoplastic Surgery, Tianjin Eye Hospital / Tianjin Key Lab of Ophthalmology and Visual Science / Nankai University Affiliated Eye Hospital / Clinical College of Ophthalmology, Tianjin Medical University / Tianjin Eye Institute, Tianjin 300020, China
  • Published:2025-07-08

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Abstract: Objective To evaluate the clinical efficacy of the modified Hughes flap in repairing large full-thickness defects of the lower eyelid. Method A prospective study of 53 patients with large full-thickness defects in the lower eyelid was conducted. The patients were divided into a modified group of 25 patients and a control group of 28 patients according to the surgical method used. In the control group, the lower eyelid was repaired using an upper eyelid tarsus conjunctival flap pedicled with Muller muscle and the conjunctiva combined with a free skin graft. In the modified group, the lower eyelid was repaired using a full-thickness upper eyelid flap pedicled with the levator aponeurosis, Muller muscle and conjunctiva. The area of the lower eyelid defect, reconstruction time, time to pedicle division surgery and complication rates were evaluated. Results No significant difference in defect size was found between the control and the modified group(P>0.05). The reconstruction time of the lower eyelid in the modified group was shorter than that in the control group［(62.1±7.4)min vs.(88.1±8.5)min, P<0.001］. The average follow-up period after surgery was 17.5±9.3 months. The waiting time for second-stage surgery in the improvement group was shorter than that in the control group ［(11.2±3.0)days vs.(21.2±2.5)days, P<0.001］. The degree of lower eyelid retraction in the improved group was lower than that in the control group(Z=-3.176,P=0.001), whereas there was no statistically significant difference in the degree of upper eyelid retraction between the two groups(t=0.351, P=0.727). Two patients(7.1%)in the control group exhibited necrosis, and no instances of wound dehiscence, upper eyelid ptosis, entropion or eversion were observed. Conclusion The modified Hughes flap can effectively repair large full-thickness defects of the lower eyelid with a simple procedure and a short waiting time before pedicle division surgery.

Key words: Blepharoplasty, Full-thickness defects of the lower eyelid, Large defect, Eyelid reconstruction, Hughes surgery, Improved surgical technique

CLC Number: 

  • R777.1
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