Incidence of host site complications in periocular full thickness skin grafts

Abstract

Aim: To evaluate the complications of periocular full thickness skin grafts (FTSG) in patients treated with Mohs' micrographic surgery (MMS) for periocular malignancy. Method: This prospective, multicentre case series included all patients in Australia treated with MMS for periocular malignancy followed by reconstruction with FTSG, who were monitored by the Skin and Cancer Foundation, between 1993 and 1999. The parameters recorded were patient demographics, reason for referral, histological classification of malignancy and evidence of perineural invasion, duration of tumour, site, recurrences prior to MMS, preoperative tumour size, and postoperative defect size. FTSG donor sites included upper lid, preauricular, retroauricular, inner brachial, and supraclavicular. The primary outcome measures were FTSG host site complications (partial/complete graft failure, graft infection, acute bleeding/haematoma, graft hypertrophy, and graft contracture). Results: 397 patients (229 males, 168 females), mean age 60 (SD 15) years (range 20-91 years). 92.7% were diagnosed with basal call carcinoma, 2.0% with Bowen's disease, and 3.3% with squamous cell carcinoma. Medial canthus was involved in 66.5% of patients, lower eyelid in 28.0%, and upper eyelid in 5.5%. Postoperative complications were recorded in 62 patients (15.6% of all patients), and consisted of graft hypertrophy (45.1% of complications), graft contraction (29.1%), and partial graft failure (12.9%). The only statistically significant association found was a higher rate of graft hypertrophy in medial canthal reconstruction (p = 0.007). Conclusion: Host site complications of periocular FTSG are not common. Graft hypertrophy accounted for most complications and was more common in the medial canthal area. No other variables such as patient demographics, tumour characteristics, or donor site factors were associated with a higher risk of complications.

Reconstructive Complications After Perioculer Mass Excision

“…Greftler genellikle genç hastalarda daha riskli olup ayrıca sigara kullananlar ve kronik hastalar da (diabet gibi) yüksek risk grubundadırlar (7).…”

“…Büyük lezyonlarda greft veya flep ile onarım komplikasyon oranını arttırmaktadır. Yapılan bir çalışmada küçük ve primer sütürasyonun yeterli olabildiği iç kantal lezyonlarda skar oluşumunun diğer bölgelerden daha sık olduğu görülmüştür (7). Ancak literatürde çok sayıda farklı komplikasyonlardan söz edilmesine rağmen iç kantal bölgede toplam komplikasyon sıklığının daha sık görülmediği bildirilmektedir (5 Postoperatuvar periorbital ekimoz (raccoon eye/s) veya hematom iyi kontol edilmemiş kanamalara bağlı ortaya çıkabilir.…”

Preauricular full-thickness skin grafting in medial canthal reconstruction

“…The first phase, which lasts 24 hours, is anischemic stage (called ''plasmatic imbibition''), followed byan edematous stage in which the graft gains up to 40% in weight, and finally revascularization of the graft (''inosculation''), which becomes apparent within 48-72 hours aftergrafting. The blood supply to the graft comes from recipientbed (''bridging phenomenon'') [6].…”

“…FTSG are nowfrequently used by plastic surgeons as anterior lamellasubstitutes in eyelid reconstruction surgery, providing tissuewith similar color, texture, and thickness.The perioculararea is considered a suitable host, having a rich vascularsupply for capillary regrowth, as well as collagen producingfibroblasts which help in graft adherence [1,2]. This successfulcombination of graft and host has subsequently made itwidely used in eyelid reconstruction surgery after trauma, burns, and tumour removal [6].The aim of the present report was to present the reconstructive techniquein inferior medial canthus with preauricular full-thicknessskin and here we showed the illustration of the respective technique.…”

“…Full thickness skin grafts (FTSG) are composed of epidermis and the entire dermis [5,6].Full-thickness eyelid defects often lead to conjunctival irritation, keratopathy, conjunctival inflammation, corneal ulceration, and even blindness [7]. FTSG are nowfrequently used by plastic surgeons as anterior lamellasubstitutes in eyelid reconstruction surgery, providing tissuewith similar color, texture, and thickness.The perioculararea is considered a suitable host, having a rich vascularsupply for capillary regrowth, as well as collagen producingfibroblasts which help in graft adherence [1,2].…”