The mainstay of treatment for a lower lid cicatricial ectropion is a full thickness skin graft ( FTSG). A FTSG has attendant problems including the need for a tie-over dressing, graft take and often delayed secondary ectropion due to contracture with possibility of further surgery. We describe a simple alternative without the attendant problems associated with a FTSG.

This involves a laterally based transposition flap ( Modified Tripier) using the lower edge of a blepharoplasty incision, with a broad base that ends at a level higher than the outer canthus. This transposition flap is turned down to fill the gap left after a sub ciliary incison has been made to relieve the cicatricial tissue. This myo cutaneous flap, acts as a hinge to provide a lateral lift which aids in the post operative cosmesis. The flap can be used medially or laterally with good results.

Seven patients who underwent an upper to lower lid tranpositon flap are illustrated. Three patients had a cicatricial ectropion and four underwent an anterior lamellar excision for a lower lid BCC.

Cosmetically the results are excellent and none of the patients have had any intra or post op complications. The average follow up was 9.4months (SD 4.1).

This technique provides a useful alternative to a full thickness skin graft. It has several advantages over a graft including reduced graft loss and uptake related problems, better vascularity and lateral elevation and the inconvenience of a tie-over dressing is avoided. This flap can be used for other lower lid pathology including reconstruction after an anterior lamellar BCC excision. However if lid laxity is noted a lateral canthopexy is required to ensure an optimal result.