Eyelid reconstruction

Published on 08/03/2015 by admin

Filed under Opthalmology

Last modified 08/03/2015

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CHAPTER 50 Eyelid reconstruction

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Fundamental principles

Skin grafts

Grafts do not have a blood supply. A skin graft may be used to fill a partial-thickness defect in the eyelid or periocular region. In a full-thickness defect of the eyelid both lamellae must be reconstructed. As noted above, one lamella must have a blood supply. A skin graft (rather than a skin flap) may be chosen for the anterior lamella if the posterior lamella has been reconstructed with a flap. One lamella must have a blood supply.

The best match of skin graft color and texture in the eyelids is full-thickness upper lid skin. To harvest the graft, mark the upper lid skin crease and excise the required size of graft from the redundant skin superior to the skin crease. Do not excise too much skin – about 23 mm of skin between the brow and the lashes must be preserved to allow comfortable closure of the eye.

If upper lid skin is not available in sufficient quantity to fill the defect, alternatives include full-thickness postauricular or preauricular skin or skin from the supraclavicular fossa. A graft of split skin may be required if the defect is too large for the available full-thickness skin. Split skin is not the first choice in the periocular region – it contracts more than full-thickness skin and its color matches periocular skin less well.

Skin grafts on mobile recipient sites, such as the upper lid, should be fixed with a bolster and tie-over sutures. A temporary central tarsorrhaphy suture between the upper and lower lids adds extra immobility to the lids while the graft is becoming vascularized. The bolster and tarsorrhaphy suture are removed after a week.

Grafts on relatively immobile sites such as the lower lid, or temple can be fixed with simple pressure dressings that are removed at a week.

Preoperative assessment

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