Blood Perfusion in a Full-Thickness Eyelid Flap, Investigated by Laser Doppler Velocimetry, Laser Speckle Contrast Imaging, and Thermography

Purpose: The eyelid is commonly dissected and divided in the process of, for example, blepharotomy, entropion repair, or when preparing a full-thickness eyelid flap to reconstruct a tumor defect. No study has yet been conducted to examine how perfusion in an eyelid is affected by dissection, using modern imaging techniques. Methods: The eyelid was divided with a 10-mm vertical incision, 5 mm from the medial canthus, and the incision was extended horizontally by 30 mm to provide a full-thickness eyelid. Blood perfusion was measured along the length of the free dissected eyelid using both laser Doppler velocimetry and laser speckle contrast imaging. Tissue temperature was visualized using a high-resolution infrared camera (thermography). Results: Measurements using laser speckle contrast imaging showed that blood flow decreased gradually from the pedicel base to the tip of the free dissected eyelid: 83% at 10 mm, stabilizing at 80% at 20 mm from the pedicel base. These results were supported by laser Doppler velocimetry, showing a reduction in perfusion to 67%, 15 mm from the pedicel base. Thermographic imaging showed a corresponding decrease in temperature from the tip to the pedicel base compared with nondissected eyelids. Conclusions: Dissection of an eyelid, to provide a full-thickness eyelid flap, results in only a slight decrease in blood flow. The results support the view that plastic surgery of the eyelids is permissive, and the rich vascularization of the eyelid due to the anastomotic network of vessels in the tarsal plate may increase the likelihood of flap survival and surgical success.