How and when of eyelid reconstruction using autologous transplantation

Abstract

Reconstructive surgery of the eyelid after tumor excision, trauma or other causes can be challenging, especially due to the complexities of the anatomic structures and to the necessity of both functional and aesthetic successful outcomes. The aim of this minireview was to investigate the use of tissue transplantation in eyelid reconstruction. Surgical procedures are various, based on the use of both flaps, pedicled or free, and grafts, in order to guarantee adequate tissue reconstruction and blood supply, which are necessary for correct healing. Common techniques normally include the use of local tissues, combining non-vascularized grafts with a vascularized flap for the two lamellae repair, to attempt a reconstruction similar to the original anatomy. When defects are too wide, vast, deep, and complex or when no adjacent healthy tissues are available, distant area tissues need to be recruited as free flaps or grafts and paired with mucosal layer reconstruction. With regards to the anterior lamella, full thickness skin grafts are commonly preferred. With regards to the reconstruction of posterior lamella, there are different graft options, which include conjunctival or tarsoconjunctival, mucosal or palatal or cartilaginous grafts usually combined with local flaps. Free flap transplantation, normally reserved for rare select cases, include the use of the radial forearm and anterolateral flaps combined with mucosal grafts, which are surgical options currently reported in the literature.

Keywords: Cartilage grafts; Dermis grafts; Eyelid lamella grafts; Eyelid reconstruction; Flap transplantation; Graft transplantation; Mucosa grafts.

Figure 1

A patient that underwent left lower eyelid reconstruction after tumor excision using a tarsoconjunctival graft (from the left upper eyelid) for the posterior lamella and a local flap for the anterior one. A: Basal cell carcinoma of left lower eyelid with preoperative markings; B: Lid after surgical removal; C: Postoperative reconstruction with Tenzel flap + tarsoconjunctival graft from the left upper eyelid; D: Clinical presentation 2 wk after surgery.