Purpose:
The use of supportive and spacer grafts is often necessary in eyelid reconstruction. These grafts are traditionally made of autologous cartilage, hard palate, or fascia lata. Although structural integrity and host immune tolerance can be achieved, a second wound and size limitations of the harvested graft can prove to be problematic. An allogeneic dermal graft (Alloderm©, LifeCell, Branchburg, NJ) has been found to produce suboptimal results when used as a substitute for the eyelid tarsal plate. More recently, a porcine-derived acellular dermis (ENDURAGen©, Stryker, Newnan, GA) has been suggested to have similar anatomical properties to those of autologous grafts.
Methods:
We performed a retrospective chart review for 6 patients in whom porcine-derived acellular dermis was used to reconstruct the periorbital adnexa by our oculoplastic surgery service. We reviewed the preoperative anatomical considerations, types of procedures performed, postoperative outcomes, and complications.
Results:
In 3 of the 6 cases, the xenograft was used as a spacer to correct lower lid retraction from adhesions to the inferior orbital rim (see figure). These patients had previously undergone orbital reconstruction by a referring otolaryngology service. One of the 6 cases involved the reformation of a severely contracted congenital anophthalmic socket that would not otherwise hold a prosthesis. Another of the 6 cases required upper lid reconstruction following trauma-related 75% loss of the eyelid. In this case, the porcine graft was sandwiched between orbicularis and conjunctival flaps during the first stage of a Cutler-Beard procedure. In the last case, the patient had lost both the eye and eyelid integrity secondary to a complicated course following a combined chemical and thermal burn. The xenograft was used for reconstruction of the upper and lower lid posterior lamellae and fornices. None of the six cases were complicated by an infection or graft failure, and none of the cases required surgical revision.
Conclusions:
In concordance with reported data, we found that ENDURAGen© was rigid, durable, and unlikely to fail or become infected. In our experience, the xenograft was comparable to autologous grafts in restoring eyelid anatomy in a variety of cases.