Pre-expanded Brachial Artery Perforator Flap: An Alternative Method for Reconstruction of Congenital Divided Eyelid Nevus.
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BACKGROUND: Divided eyelid nevus is a rare congenital anomaly leading to functional and aesthetic issues, with a potential risk of malignant transformation. The aim of reconstruction is to provide tissue that closely matches the eyelid skin in color, texture, and thickness while minimizing donor-site morbidity. This study evaluated the efficacy of the pre-expanded brachial artery perforator (BAP) flap in reconstructing defects following resection of a divided eyelid nevus. METHODS: There are fifteen patients who underwent eyelid reconstruction procedures involving tissue expansion, flap transfer, and pedicle division between December 2014 and December 2024. Patient demographics, flap characteristics, postoperative flap survival, and aesthetic outcomes were assessed. RESULTS: All 15 pre-expanded BAP flaps, ranging in size from 15 × 7 cm to 20 × 13 cm (mean 17.6 × 8.7 cm), survived without complications. The size of the expanders ranged from 100 to 200 mL (mean 146.7 mL), with an expansion duration of 4-9 months (mean 6.2 m onths). The defect dimensions ranged from 5 × 3 cm to 15 × 8 cm (mean 8.8 × 6.2 cm). Donor sites were primarily closed in seven patients, while eight patients required reconstruction using a pre-expanded latissimus dorsi myocutaneous flap. No secondary deformities were noted. All patients were satisfied with the aesthetic outcomes of the reconstructed eyelids and donor sites. CONCLUSIONS: The pre-expanded BAP flap can be used to reconstruct defects following resection of divided eyelid nevus, providing consistent functional and aesthetic outcomes. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors https://www.springer.com/00266 .