Use of periocular superficial musculo-aponeurotic system flap and hard palate mucosal graft in reconstruction of full-thickness eyelid defects

Abstract

To investigate the outcome of combining grafting of periocular superficial musculo-aponeurotic system (SMAS) flaps and hard palate mucosa in the reconstruction of modest and severe full-thickness eyelid defects. Hard palate mucosa was grafted to replace the posterior layers of the eyelid (the tarsus and the conjunctiva) while periocular SMAS flap, which is rich in blood supply, was utilized to reconstruct the anterior layers of the eyelid (the skin and muscular layer). Among the 26 eyes of 26 patients treated with full-thickness eyelid defects of half or more palpebral length, orbicularis muscular flaps were utilized in 5 cases, superficial temporal arterial flaps in 5 cases, supra-eyebrow flaps in 7 cases and upper eyelid skin-orbicularis bipedicled flaps in 9 cases. The operation began with the grafting of hard palate mucosa. Periocular SMAS flaps were then designed according to the location and scope of the defect of the anterior layers of the eyelids and transposition procedure ensued. After the grafting procedures, tarsorrhaphy was performed in all cases and the closure was maintained for 3 months. All patients were followed for 6 to 36 months, averaged 11 months. The flaps and hard palate mucosal grafts existed well in all cases. No shrinkage in hard palate mucosal grafts was observed and satisfactory aesthetic and functional results were achieved. Combining grafting of periocular SMAS flap and hard palate mucosa can repair full-thickness eyelid defects as a one-stage operation with definite and good outcome.