The use of acellular human dermis composite graft for upper eyelid reconstruction in ocular injury

Abstract

Repair of the upper lid is more difficult because of the unique anatomic requirements of the upper eyelid. The eyelid must remain pliable, allow for retraction and protraction, and also have a mucous membrane on the posterior surface. A number of procedures are available to repair large to total upper eyelid defects. These surgical techniques include lower lid switch flaps and lower lid bridge flaps. However, these procedures have several disadvantages, such as the partial or total sacrifice of the lower lid and the need for secondary correction. The authors present a new surgical technique using composite graft of acellular dermis and split-thickness buccal mucosa in the reconstruction of traumatic full-thickness upper eyelid defects to achieve satisfactory functional and esthetic results. In this retrospective case series, eight patients requiring full-thickness upper eyelid reconstruction were evaluated. Defect size ranged from 20 mm to 28 mm horizontally and from 5 mm to 8 mm vertically. For eyelid reconstruction, the acellular dermis composite graft was sutured into the posterior lamella defect; the anterior lamella was repaired with a bipedicled orbicularis flap and a free skin graft. Acellular dermis composite grafts achieved complete resolution of lagophthalmos and follow-up of 6 months to 31 months revealed a good outcome in all eight cases. No adverse situation of the grafts viability was encountered. Postoperative complications occurred in two patients; one had eyelid margin notching and the other had a mild ptosis. The acellular dermis composite graft is a good match for the posterior lamella of the eyelid in terms of texture and contour. The acellular dermis composite graft technique is useful for the reconstruction of large upper eyelid defects resulting from burns or trauma because this method results in complete repair of defects without causing notable deformity.