Autologous buccal mucosal graft combined with orbicularis oculi myocutaneous flap for single-stage reconstruction of full-thickness lower eyelid defects following Mohs micrographic surgery: a case report with literature review.

BACKGROUND: Large full-thickness lower eyelid defects following Mohs micrographic surgery (MMS) for basal cell carcinoma (BCC) present a substantial reconstructive challenge. This challenge is further compounded in elderly patients with systemic comorbidities, for whom general anesthesia and staged procedures carry risks that must factor into technique selection. We illustrate this in an 84-year-old woman with advanced chronic kidney disease. CASE PRESENTATION: An 84-year-old woman with chronic renal insufficiency (estimated glomerular filtration rate 15.96 mL/min/1.73 m², serum creatinine 249.9 μmol/L; chronic kidney disease stage G4) presented with a progressively enlarging, ulcerated nodular-type BCC on the right lower eyelid. Following two stages of MMS, a 2.6 cm × 1.6 cm full-thickness defect remained. Single-stage reconstruction was performed under local anesthesia using an autologous buccal mucosal graft for the posterior lamella and an orbicularis oculi myocutaneous flap for the anterior lamella. The flap demonstrated normal perfusion immediately after surgery. At approximately six-month follow-up, complete eyelid closure and restored lid function were maintained, with a stable, natural lid contour and no clinical signs of graft contracture, ectropion, corneal exposure, or local tumor recurrence. CONCLUSION: This case suggests that autologous buccal mucosal graft combined with an orbicularis oculi myocutaneous flap may offer a viable single-stage reconstructive option for large full-thickness lower eyelid defects following MMS, and may be particularly relevant for elderly patients with systemic comorbidities. Given the single-case design and limited follow-up duration, prospective evaluation in larger series is needed to confirm these preliminary findings.