Biomaterials for tarsal plate reconstruction and our innovative work

Abstract

Large tarsal plate defect reconstruction is one of the most challenging tasks for plastic surgeons. Based on our practical work and literature review, the techniques and postoperative results of the preserved sclera, ear cartilage, and acellular dermal matrix (ADM) as tarsal plate substitutes were investigated. Two cases were reviewed. Case 1 was a 22-year-old female who had total loss of the right lower eyelid. Ear cartilage (23 ​mm ​× ​25 ​mm) was implanted under the expanded skin during the forehead skin-expanding procedure to form a skin-cartilage-expander capsule compound structure for lower eyelid reconstruction. Case 2 was a 7-year-old boy with a unilateral divided nevus. The lid and conjunctiva of the lower eyelid were invaded. A piece of ADM (12 ​mm ​× ​4 ​mm) was used to repair the tarsal plate defect (12 ​mm ​× ​3 ​mm). The conjunctiva of ADM was covered by itself. An orbicularis oculi myocutaneous flap was used for anterior lamella reconstruction. In case 1, the compound tissue survived and supported the lower eyelid, the lid margin was clear, and the structure was complete over a 1-year follow-up. The aesthetic appearance of the eyelid improved after depilation. It is the first clinical research on the expander capsule as eyelid conjunctiva. In case 2, the conjunctiva completely covered the superior ADM, and the transplant merged with the surrounding tissues without complications after 5 months. The preserved sclera has the longest application history as a tarsal plate substitute. However, it should be preserved in an eye bank and transplanted with conjunctiva repair. Ear cartilage is an autologous tissue that requires conjunctival reconstruction. Our clinical practice was the first to prove the possibility of the expander capsule as eyelid conjunctiva. It is feasible to prefabricate the skin-tarsal conjunctiva complex during the skin expansion procedure. Allogeneic ADM is a common clinical material with advantages of good biological histocompatibility, supportive strength, conjunctivalization, and not requiring donor site surgery. Plastic surgeons are familiar with autologous ear cartilage and ADM, which are easy to obtain and treat. Both ear cartilage and ADM are expected to be the first-line choices in future studies.