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Neel Kumar, Shalin Shah, Adham al-Hariri; The Use of Commercially Available Grafts in Lower Eyelid Reconstruction. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3040.
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The use of supportive and spacer grafts is often necessary in eyelid reconstruction. While the use of autologous grafts minimizes tissue rejection and restores structural integrity, the size of harvested grafts and secondary wound morbidity can be limiting factors. Although commercial grafts have become increasingly available over the past decade, it is not clear which graft(s) are best to restore the eyelid’s complex anatomy and function. Furthermore, there is little information documenting the use of these grafts in combination.
A retrospective chart review was performed and 6 patients were identified with cicatricial lower eyelid retraction requiring allogeneic, xenographic, or bioengineered grafts. We examined the preoperative anatomical considerations, types of procedures performed, postoperative outcomes, and complications.
Multiple commercially available grafts were utilized depending on the level of injury within the eyelid to restore anatomic and functional properties in all 6 patients. The most complex reconstruction was for a patient who had an iatrogenic cicatricial entropion and eyelid retraction with hardware adhesion to an extruding orbital implant. The patient suffered from epiphora, inferior scleral show, and lagophthalmos with exposure keratopathy. An allogeneic dermal graft (Alloderm©,LifeCell, Branchburg, NJ) was used to cover the titanium plates and prevent future adhesions. A bioengineered eyelid spacer graft (tarSys™, IOP Ophthalmics, Costa Mesa, CA) was used to reconstruct the lower eyelid posterior lamella (FIGURE 1). Finally, an allogeneic amniotic membrane (Ambio5®, IOP Ophthalmics, Costa Mesa, CA) was used to reconstruct the palpebral conjunctiva. The other patients received either a porcine-derived acellular dermis (ENDURAGen©, Stryker, Newnan,GA) or tarSys™. None of the patients developed an infection or graft rejection.
Commercially available grafts are establishing their role in lower eyelid reconstruction. While the goal in tissue selection usually focuses on restoring form, the dynamic properties of the lower eyelid should also dictate the choice of graft. Depending on the layer(s) of the eyelid involved, this is currently achievable with an array of grafts used alone or in combination. The complex anatomy and function of the lower eyelid can be safely simulated without donor site morbidity or significant complications.
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