Revascularization of Free Skin Grafts Overlying Modified Hughes Tarsoconjunctival Flaps Monitored Using Laser-Based Techniques

Abstract

Purpose: It has recently been shown that the flap pedicle does not supply blood to a tarsoconjunctival graft in the modified Hughes procedure in patients. This raises questions concerning the rate of revascularization of the free skin graft commonly used to reconstruct the anterior lamella. The aim of this study was, thus, to monitor the course of revascularization in free skin grafts overlying modified Hughes tarsoconjunctival flaps, using laser-based techniques. Methods: Free skin grafts from the upper eyelid or upper arm in 9 patients were used to cover a tarsoconjunctival flap according to the modified Hughes procedure. Blood perfusion was monitored using laser speckle contrast imaging, and vascular reactivity was studied with laser Doppler velocimetry after heating the tissue to 44°C. Measurements were made at the time of surgery (baseline) and at 1, 3, 8, and 16 weeks postoperatively. Results: The gradual increase in perfusion of the free skin grafts during the healing process indicates revascularization. A slight increase in perfusion was seen already after 1 week. Perfusion reached 50% of the baseline after 3 weeks, and complete restoration of perfusion was seen after 8 weeks. The vascular function monitored with heat-induced hyperemia increased in a similar fashion. Conclusions: Full-thickness skin grafts revascularize within 3 to 8 weeks, despite overlying a tarsoconjunctival flap, which has recently been reported to be avascular. This provides further evidence that it should be possible to repair large eyelid defects using free full-thickness eyelid grafts.

Blood Perfusion of Human Upper Eyelid Skin Flaps Is Better in Myocutaneous than in Cutaneous Flaps

“…Free skin grafts are known to survive well in the well-perfused periocular area, as shown in our previous studies on free full-thickness skin grafts used on their own to repair defects 14 or in combination with tarsoconjunctival flaps. 15 A flap is often thinned to achieve better reconstructive results, especially in the face. 16 However, flap thinning can compromise the vascular supply of the flap.…”

Laser Speckle Contrast Imaging of the Blood Perfusion in Glabellar Flaps Used to Repair Medial Canthal Defects

“…The survival rate of free skin grafts in the well-perfused periocular area is known to be high, as shown in previous studies on free full-thickness skin grafts used on their own to cover defects, 19 or in combination with tarsoconjunctival flaps. 20 Indeed, it is common practice to combine a glabellar flap with other local flaps in cases of very large medial canthal defects, to reduce the length of the flap. For instance, in a case report from 2017, Ogino et al used a glabellar flap, an upper eyelid myocutaneous advancement flap, and a cheek rotation flap to cover a medial canthal defect, while the donor site of the glabellar flap was covered by a Rintala flap.…”

“…Indeed, the authors have shown in previous studies that free full-thickness skin grafts in the periocular area require 7 weeks to become fully reperfused. 19 , 20 …”

“…Indeed, the authors have shown in previous studies that free full-thickness skin grafts in the periocular area require 7 weeks to become fully reperfused. 19,20 Considering that the distal part of the flap does not seem to be perfused, the combination of a glabellar flap and a free full-thickness skin graft could be considered in cases where a long flap is required. The survival rate of free skin grafts in the well-perfused periocular area is known to be high, as shown in previous studies on free full-thickness skin grafts used on their own to cover defects, 19 or in combination with tarsoconjunctival Copyright © 2021 The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc.…”

Surgical Strategies for Eyelid Defect Reconstruction: A Review on Principles and Techniques

“…FTSG is suitable for simple anterior lamellar defects with a healthy orbicularis base [ 7 , 8 ] or for use in combination with vascularized posterior lamellar replacements for bilamellar defects [ 9 , 10 ]. Aesthetically, skin tissues from the ipsilateral or contralateral eyelid, retroauricular, inner brachial, and supraclavicular areas that provide similar color, thickness, and texture are considered ideal donor sites for the periocular region [ 11 ].…”