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E. P. McCartney, S. Merbs, M. Grant, N. Iliff; Use of Porcine Dermal Collagen for Reconstruction in Upper Eyelid Defects. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2292.
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Several options have been described to reconstruct an upper eyelid following tumor resection or trauma. Most require a tarsal substitute to provide stability to the reconstructed upper eyelid, and ear cartilage is probably most commonly used. We describe a method using porcine dermal collagen as a tarsal substitute after total upper eyelid resection, which eliminates donor-site morbidity.
The upper eyelid is either reconstructed with a Cutler-Beard or other advancement flap. Rather than ear cartilage, porcine dermal collagen (Enduragen, Porex Surgical, Inc) is used between the skin/muscle and conjunctival flaps. The conjunctiva should be wrapped around the inferior edge of the collagen graft and sutured to the skin muscle advancement flap. In the representative patient, the upper eyelid was resected for a sebaceous cell carcinoma, sparing the tissue above the lid crease. A superior skin/muscle flap and a superior forniceal conjunctival flap were mobilized and advanced inferiorly. Dermal collagen was used as a tarsal substitute between the flaps.
The patient did well post-operatively with an excellent upper eyelid contour. During a 6-month follow up period, the upper eyelid maintained its contour. No signs of infection or inflammation as a result of the graft were observed.
Porcine dermal collagen appears to provide sufficient support to a reconstructed eyelid and should be considered as a tarsal substitute. Dermal collagen has the distinct advantage that it does not require a donor site like ear cartilage. Longer follow up in more patients will be needed to confirm the likely possibility that dermal collagen maintains its shape and support, in contrast to cartilage, which has the possibility of growing and changing shape.
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