Reconstruction of Total Upper and Lower Eyelid Defects with a Preserved Eye Globe Using a Free Radial Forearm Flap and Buccal Mucosal Graft Following a Japanese Black Bear Attack; A Case Report

An 87-year-old man was injured in a Japanese black bear (Ursus thibetanus japonicus) attack, and his left upper and lower eyelids were completely lost. The patient's left eye globe did not rupture; therefore, enucleation was not indicated. Total upper and lower eyelid reconstructions were performed using a free radial forearm flap and buccal mucosal graft. The patient now lives without the regular use of ophthalmic solutions. The reconstructed eyelids do not have an opening; thus, the left eye does not have practical visual function. However, the cornea does not dry out. Few case reports have described the reconstruction of total upper and lower eyelid defects with an intact eye globe. In particular, reports on reconstruction using free flaps are rare. Therefore, we describe this challenging case and discuss reconstruction of total upper and lower eyelid defects along with a few previous case reports.