IN REMOVING large cancerous lesions from the medial canthus, the ophthalmologist is faced with the responsibility of not only effecting a cure by total excision but also resolving the structural and cosmetic consequences of the excision.
In Smith's technique of reconstruction1 a tarsoconjunctival flap is used from the upper lid to maintain the tectonic stability of the remaining lid substance (Fig 1). This flap maintains the continuity of the tarsal portion of the lid. It aids in the prevention of contracture of the unrestrained orbicularis muscle. A direct suture of the flap to the medial canthal ligament remnant is undertaken to reestablish support.
In lid lacerations involving the lower canaliculus and medial canthal ligament Scheie2 has designed a technique to maintain the continuity of the lower lid margin by also using a tarsal flap. His method creates a new medial canthal support when the ligament has been previously
Jack MK. A Technique of Plastic Reconstruction of the Medial Canthus. Arch Ophthalmol. 1967;78(6):740-741. doi:10.1001/archopht.1967.00980030742009