Case report: the use of a modified Tenzel-type flap to reconstruct two separate peri-ocular defects

Basal cell carcinomas in the peri-ocular area account for about 20% of head and neck carcinomas [1], and synchronous non-melanoma skin cancers are a frequent occurrence, in one study occurring in 39% of patients [2]. A well-recognised and excellent way of bringing thin, texture and colour-matched skin to cover lower lid defects which cannot be closed are cheek rotation flaps [3, 4]. However, normally, the presence of a second lesion on the ipsilateral lateral canthus would prevent such flaps from being possible. Here we describe a novel modification of the Tenzel-type flap to simultaneously reconstruct two defects arising from the excision of basal cell carcinomas—one on the inferior eyelid and one on the lateral canthus. Both carcinomas were completely excised, and the patient had a good cosmetic result. The underlying concept is the integration of what may initially appear to be two mutually exclusive local flaps.