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E. Hatef Naimi, B. Hayek, M. Nguyen, V. Ho, A. Hsu, B. Esmaeli; Upper Eye Lid Reconstruction with Acellular Dermal Graft (AlloDerm) in Cancer Patients. Invest. Ophthalmol. Vis. Sci. 2007;48(13):5226.
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To evaluate the feasibility of utilizing acellular dermal graft (AlloDerm, LifeCell Corporation, Branchburg, New Jersey) in posterior lamellar eyelid reconstruction after ablative surgery for eyelid cancers.
A query of the database of the Ophthalmology Section at M. D. Anderson Cancer Center was conducted for all patients who had Alloderm used as a component of their reconstructive surgery between July 2005 and July 2006. The clinical records and pre- and post-operative photographs were reviewed in each case. Functional and cosmetic outcomes and post-operative complications were assessed in each case.
There were 4 women and 1 man with an age range of 52 to 86 years (median, 80 years). All 5 patients had surgery by the same oculoplastic surgeon (B.E). Two patients had recurrent sebaceous cell carcinoma of the upper eyelid, 2 had melanoma of upper eyelid and palpebral conjunctiva, 1 had squamous cell carcinoma of the upper eyelid skin. Wide local excision of the eyelid mass and repair was done in each case. The upper eyelid defect size involved the entire width and full thickness of the upper eye lid in 4 patients and half to two thirds of upper eye lid (full-thickness defect) in 1 patient. In 1 patient with sebaceous cell carcinoma of the upper eyelid, the entire lower eye lid was also involved. The reconstructive procedure for the upper eyelid defect included a modified Cutler-Beard procedure using Alloderm as the posterior lamellar spacer material in all 5 patients. In 1 patient, with total upper and lower eyelid loss, Alloderm graft was used for reconstruction of the lower eyelid tarsal component in addition to reconstruction of the upper eyelid defect. Postoperative follow-up time ranged from 3 to 17 months (median, 5 months). Satisfactory functional and cosmetic outcome were obtained in all 5 patients. Two patients had some residual exposure keratopathy; 1 underwent additional surgery to correct her recurrent corneal abrasion. Allergic reaction to Alloderm, infectious transmission, and immunologic rejection have not been encountered in any of the patients at the time of this report.
AlloDerm can be used as an alternative spacer material for reconstruction of the posterior lamella in large upper eyelid defects using a modified Cutler-Beard procedure when no other autologous alternatives are available. Longer follow-up time and a larger study are required to fully evaluate this material for posterior lamellar eyelid reconstruction in cancer patients.
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