Posterior Lamellar Reconstruction Using a Free Tarsoconjunctival Graft for a Large Lower Eyelid Defect

Reconstruction of the posterior lamella after excision of lower eyelid malignancies is essential to prevent postoperative functional complications. Free tarsoconjunctival grafting (FTG) allows single-stage reconstruction but is commonly applied to small to moderate defects, as graft survival depends on rapid revascularization. A case of basal cell carcinoma (BCC) of the lower eyelid is presented, in which posterior lamellar reconstruction was successfully performed using FTG for a relatively large defect measuring approximately 15 mm in width, which exceeds the size commonly selected in dermatologic practice. After full-thickness excision with a 2-mm margin, FTG was combined with a cheek rotation flap for anterior lamellar reconstruction. At six months postoperatively, mild ectropion was observed without corneal exposure or lagophthalmos, and both functional and cosmetic outcomes were satisfactory. This case suggests that FTG, when combined with a well-vascularized anterior lamellar flap, may be feasible in selected cases with larger posterior lamellar defects.