Abstract
Purpose :
Full thickness defects of the lower eyelid offer a particular challenge to ophthalmic surgeons in terms of satisfactory operative reconstruction. Several management options and surgical approaches currently exist for the reconstruction of such defects. It has been demonstrated the tarsoconjunctival flap pedicle does not appear to supply the flap and the vascularization of the remaining eyelid/tear film is thought to offer adequate nourishment for survival of the flap. A swine model was constructed to assess the viability of a bilamellar graft from the upper lid for repair of a full thickness lower lid defect.
Methods :
Full-thickness defects of varying sizes were created in each lower eyelid of four Yorkshire/Yorkshire crossed swine. The defects were then closed with a full thickness ipsilateral graft from the upper eyelid. The subjects were then monitored post-operatively and assessed clinically for graft viability at post-operative days one, seven, and thirty. At the conclusion of the thirty day post-operative monitoring period, necropsy was performed and histopathologic analysis utilized to assess cell morphology and vessel ingrowth of the graft sites. All animals received humane care in compliance with the Policy for the Humane Care and Use of Laboratory Animals. The pigs were not utilized for any other research purpose by the clinical research team.
Results :
In total, eight full-thickness bilamellar grafts were constructed and examined. At the conclusion of the post-operative monitoring period, all grafts were deemed clinically viable and vascular ingrowth was determined to be equivalent to unaffected eyelid sections by histologic analysis. No clinically significant notching of the graft sites were noted. No cases of post-operative hematoma, wound infection, wound dehiscence, or forniceal shortening were identified.
Conclusions :
This analysis demonstrates the viability of a full-thickness bilamellar graft as a surgical alternative in the repair of full-thickness eyelid defects in a porcine model. The post-operative outcomes are consistent with the recent literature. Additional studies need to be performed to assess the procedure’s clinical utility in human subjects before incorporation into clinical practice.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.