LAUSR

We present the case of a 79-year-old lady who underwent excision biopsy of a likely basal cell carcinoma resulting in a full-thickness lateral lower lid defect to the lateral orbital rim (Figure 1a). Typically, closure of such a defect involves a lateral periosteal or a tarsoconjunctival flap. Possible grafts used to reconstruct the posterior lamella would include mucosal grafts harvested from the hard palate or nasal septum, or cartilage from the ear. We describe posterior lamellae reconstruction of a lateral lower lid full-thickness defect with a flap fashioned from an Lshaped relieving incision to the fibres of the inferior crus of the lateral canthal tendon (Figure 1b and Figure 2a) creating a strip that is rotated (Figure 2b), advanced medially and anastomosed to the adjoining tarsal plate (Figure 1d & Figure 2c). The laxity of the surrounding periorbital skin in this case permitted anterior lamella reformation with simple undermining of periocular tissue and skin advancement (Figure 2d). Four weeks postoperatively, the patient had a favourable cosmetic result with an excellent lower eyelid contour which can be sometimes difficult to achieve with alternative methods such as periosteal flaps. Leaving the lateral canthal tendon intact ensured good horizontal lid stability (Figure 3). Furthermore, she had no symptoms of foreign body sensation or epiphora, and clinical examination showed no evidence of corneal or conjunctival staining. In summary, we describe a one-step surgical technique to reconstructing the posterior lamella in large lateral full-