Cutler Beard


The Cutler-Beard flap is a staged lid-sharing procedure that transfers a full-thickness flap from the lower eyelid to an upper eyelid defect (10) (Fig. 7). The technique involves creating a transcutaneous full-thickness horizontal incision below the level of the marginal vessels in the lower eyelid (4 mm below the lid margin), equal in extent to the upper eyelid defect. Full-thickness vertical inferior cuts are made that create a rectangular flap based inferiorly that is pulled superiorly under the inferior eyelid margin to the upper lid defect. The flap is composed of skin, orbicularis oculi muscle, orbital septum, capsulopalpebral fascia, and conjunctiva. The capsulopal-pebral fascia at the leading edge of the flap is sutured to the levator aponeurosis in the upper eyelid as part of a layered closure. The flap is left in place 6-8 weeks for delay and to allow lengthening. The second stage consists of flap division allowing excess conjunctival tissue to drape over the upper lid margin. The lower lid is closed in layers including conjunctiva.


It can be used for full-thickness upper eyelid defects involving over 75% of the upper eyelid margin. Like the Hughes flap, this flap is contraindicated for patients with ocular disease that require regular examinations or those with very poor or no sight in the opposite eye.


The advantages of this flap include replacement of similar tissue from that lost in the upper eyelid and provision of a natural lining for corneal protection.


Vision is obstructed for a prolonged period of time prior to flap division and inset. -g

Since no tarsus or rigid structure is restored in the upper eyelid margin, entropion |

may result. Postoperative ectropion in the lower eyelid is also a significant risk. | There are no lashes on the reconstructed lid margin.

Switch Flap (for Upper Eyelid Repair) '5

Description o

The switch flap is a two-stage procedure involving transfer of a wedge-shaped full-thickness marginal flap from the lower eyelid to the upper eyelid (11). The @

Full Thickness Repair Eyelid Margin

Figure 7 Cutler-Beard flap for upper eyelid reconstruction.

Figure 7 Cutler-Beard flap for upper eyelid reconstruction.

hinge of the flap should lie at the midpoint of the upper lid defect, and the flap is pedicled medially closing the visual axis after transfer to the upper lid. The height of the flap should be at least 4 mm from the lid margin preserving the g marginal arcade. At the second stage (2-3 weeks later), the pedicle is divided g and the lower eyelid is closed primarily by any appropriate technique as described -f in this section.

Indications |

The main indication for the switch flap is for central marginal upper eyelid defects involving 50% of the lid margin. This technique transfers full-thickness lower eyelid, ยง

together with the lashes, into the upper eyelid defect.


The major advantage of the switch flap is that it replaces similar tissue to that lost in the upper eyelid, including the eyelashes.


A disadvantage to this flap is that is requires two stages, and vision in the affected eye is interrupted during the delay period.

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