Autologous Chondral-Pericondral Graft as an Alternative for Internal Lining Lower Lid Reconstruction: A Clinical and Cytological Follow-Up

Abstract

Purpose: : To assess surgical outcomes following lower lid reconstruction surgery using auricular conchal tissue.

Methods: : This prospective clinical study included 20 patients recruited from our Department of Plastic Surgery in collaboration with our Departments of Ophthalmology from 2002 to 2007. All patients underwent reconstructive lower lid surgery using an autologous chondral-pericondral graft. Although various types of graft surgery can be used in order to provide adequate support and protection to the ocular bulb and corneal surface, we use chondral-perichondral tissue because of the following advantages, which include: 1. conchal cartilage provides good mechanical support in the reconstructed lid, thus reducing the risks of ectropion and corneal exposure; and, 2. perichondral tissue being in direct contact with the bulbar conjunctival aids in the new conjunctival formation of the reconstructed portion of the lid, thus minimizing ocular complications. Patients were followed by both plastic surgeons and ophthalmologists weekly for the first month, then monthly. Biopsies were taken after 1 year and assessed with histopathology and cytology analysis to determine the presence of conjunctiva tissue. In particular, cytology analysis using CK 19 was used to confirm newly formed conjunctiva overlying the graft.

Results: : All 20 patients did not show any sign of graft rejection and had generally good surgical outcomes with minimal or no ocular complications. 16 of 20 patients had excellent functional and aesthetic results (mean follow-up 3 years). Surgical outcomes were highly dependent on proper post-op conjunctiva formation. All patients were positive for CK 19, thus indicating proper conjunctiva tissue formation. Four of the 20 patients underwent surgery in 2007, thus have limited follow-up results and have not undergone biopsies.

Conclusions: : Lower lid reconstruction surgery using auricular chondral-pericondral conchal tissue is a good alternative in patients with neoplastic lesions. Surgical outcomes show good functional, and morphological results, providing adequate ocular surface protection.

Keywords: tumors • conjunctiva • eyelid