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Auricular cartilage has been largely reported as an available substitute of defected tarsus to restore lower eyelid stability. However, undesirable results such as displacement, detachment, warping, down-gaze disturbance, and surface irregularity of the cartilage graft have been reported in previous reports, some of which require reoperations. In this study, the authors present a new technique to use strips of auricular cartilage with a local flap to restore the lower eyelid stability for a reliable eyelid support.
From 2013 to 2018, the technique was carried out on 13 patients who suffered inadequate lower eyelid support with cicatricial retraction or ectropion and incomplete eyeball coverage, which was caused by soft tissue deletion secondary to different etiologies. Two kinds of local flaps were used to reconstruct the anterior soft tissue layer, whereas the posterior layer was supported with a π-shaped auricular cartilage. The preoperative and postoperative photographs were taken. Three indexes, including the vertical distance between inferior corneal margin and inferior palpebral margin, the maximal breadth of palpebral conjunctiva caused by ectropion, and the maximal palpebral fissure breadth when eyelid is closed, were measured before and 6 months after the operation to evaluate the operative effect.
The average follow-up was 32 months (range, 6–62 months). The local flap survived in all patients. No complications were seen in any of the patients. Postoperative average of the aforementioned first 2 indexes measured at 6 months was 0 mm, whereas the preoperative one was 2.69 and 1.08 mm, respectively. Postoperative average of the third index was also far more lower than the preoperative one (0.08 vs 2.77 mm). The difference between the preoperative and postoperative evaluation of the 3 indexes was statistically significant (paired t test, P < 0.001). No further intervention was required.
The present technique using a combination of π-shaped auricular cartilage and a local flap provides a satisfying horizontal and vertical support to maintain the lower eyelid in a normal position without compromising the mobility of the lower eyelid. This technique can be used as an effective and safe method for lower eyelid support.

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