The Hughes procedure is a two-staged operation for reconstruction of total or near total lower eyelid defects. As with the free tarsoconjunctival graft, a block of tarsus and conjunctiva is marked out on the ipsilateral upper lid. However, the upper border is left attached superiorly and a conjunctival flap is dissected off of the underlying Muller's muscle to the superior fornix (Fig. 10). The tarsal flap is advanced down into the lower lid defect and sutured to residual tarsus or canthal tendons and the lower lid retractors. The anterior lamella is reconstructed with a skin graft or myocutaneous flap. After three weeks the conjunctival flap is cut off along the new lower lid margin.
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