Use of Split-Thickness Dermal Graft in the Surgical Treatment of Corneal and Scleral Defects

Mauriello, Joseph A.; Fiore, Philip M.; Pokorny, Kathryn S.; Cinotti, Donald J.

doi:10.1016/0002-9394(88)90003-7

Cited by 18 publications

(4 citation statements)

References 9 publications

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“…This allows blood vessels to connect with the vessels and in the graft that carry blood to the affected cornea, helping it heal. Other methods that have been tried for grafts to maintain globe integrity include buccal mucous membrane grafts, split thickness dermal grafts, and tenon's capsule grafts (Ma'luf and Awwad, 2005;Mauriello et al, 1988;Reim et al, 1992).…”

Section: Conjunctival Flapmentioning

confidence: 99%

Neurotrophic keratopathy

Dua

Said

Messmer

et al. 2018

Progress in Retinal and Eye Research

289

356

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Neurotrophic Keratopathy (NK) refers to a condition where corneal epitheliopathy leading to frank epithelial defect with or without stromal ulceration (melting) is associated with reduced or absent corneal sensations. Sensory nerves serve nociceptor and trophic functions, which can be affected independently or simultaneously. Loss of trophic function and consequent epithelial breakdown exposes the stroma making it susceptible to enzymatic degradation. Nerve pathology can range from attrition to aberrant re-generation with corresponding symptoms from anaesthesia to hyperaesthesia/allodynia. Many systemic and ocular conditions, including surgery and preserved medications can lead to NK. NK can be mild (epithelium and tear film changes), moderate (non-healing epithelial defect) or severe (stromal melting and perforation). Moderate and severe NK can profoundly affect vision and adversely impact on the quality of life. Medical management with lubricating agents from artificial tears to serum/plasma drops, anti-inflammatory agents, antibiotics and anti-proteases all provide non-specific relief, which may be temporary. Contact lenses, punctal plugs, lid closure with botulinum toxin and surgical interventions like tarsorrhaphy, conjunctival flaps and amniotic membrane provide greater success but often at the cost of obscuring sight. Corneal surgery in a dry ocular surface with reduced sensation is at high risk of failure. The recent advent of biologicals such as biopolymers mimicking heparan sulfate; coenzyme Q10 and antisense oligonucleotide that suppress connexin 43 expression, all offer promise. Recombinant nerve growth factor (cenegermin), recently approved for human use targets the nerve pathology and has the potential of addressing the underlying deficit and becoming a specific therapy for NK.

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Section: Conjunctival Flapmentioning

confidence: 99%

Neurotrophic keratopathy

Dua

Said

Messmer

et al. 2018

Progress in Retinal and Eye Research

289

356

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“…Other causes of corneoscieral defects were scleromalacia perforans, idiopathic systemic vasculitis, alkali burn, ocular cicatricial pemphigoid, and band keratopathy with recurrent erosion following intraocular metallic foreign body. We propose the use of split-thickness grafts: (1) when adjacent conjunctiva is inadequate to cover a corneoscieral defect owing to its large size or great depth or to conjunctival scarring from previous operations, injury, or ocular cicatricial pemphigoid; or (2) as an alternative to autogenous grafts such as conjunctiva, cartilage, fascia lata, tibial periosteum, or mucous membrane as well as to homologous scleral and lamellar grafts. Dermal grafts are advantageous in that they are autogenous, non-antigenic, survive on avascular surfaces, and self-epithelialise and, thus, need not be covered by conjunctiva.…”

Section: Joseph a Mauriello Jr Kathryn Pokornymentioning

confidence: 99%

Use of split-thickness dermal grafts to repair corneal and scleral defects--a study of 10 patients.

Mauriello

Pokorny

1993

British Journal of Ophthalmology

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The use of split-thickness dermal grafts for successful repair of corneal and scieral defects is reported in 10 patients (11 eyes) who had non-infectious, impending, or overt ocular perforation. In all patients, traditional methods of reconstruction were deemed inappropriate or had already failed. Corneoscieral defects occurred after various operations: pterygium excision, retinal detachment repair, insertion of a keratoprosthesis (Cardona implant) into an opaque, vascularised cornea, and penetrating keratoplasty. Other causes of corneoscieral defects were scleromalacia perforans, idiopathic systemic vasculitis, alkali burn, ocular cicatricial pemphigoid, and band keratopathy with recurrent erosion following intraocular metallic foreign body. We propose the use of split-thickness grafts: (1) when adjacent conjunctiva is inadequate to cover a corneoscieral defect owing to its large size or great depth or to conjunctival scarring from previous operations, injury, or ocular cicatricial pemphigoid; or (2) as an alternative to autogenous grafts such as conjunctiva, cartilage, fascia lata, tibial periosteum, or mucous membrane as well as to homologous scleral and lamellar grafts. Dermal grafts are advantageous in that they are autogenous, non-antigenic, survive on avascular surfaces, and self-epithelialise and, thus, need not be covered by conjunctiva. Furthermore, they are pliable, have excellent tensile strength, provide ample tectile support, and are abundantly available. Dermal grafts are harvested from the dermal bed of the thigh after an epidermal flap is hinged at one end. (BrJ Ophthalmol 1993; 77: 327-331) flap; the patient was fitted postoperatively with a cosmetic scleral shell.3 We report the use of split-thickness dermal grafts in 10 patients with corneoscleral defects for whom traditional methods were thought to be unsatisfactory or had already been attempted and failed. " Methods INDICATIONS FOR DERMAL GRAFTINGIndications for dermal grafts included: (1) small (1-2 mm) corneoscleral perforations, (2) areas of corneoscleral thinning too large or of too great a depth to be covered by other types ofgrafts or by adjacent conjunctiva, and (3) severe conjunctival scarring which precluded mobilisation of a conjunctival flap over the corneal or scleral defect. For the above reasons alternative methods such as cyanoacrylate tissue adhesive and bandage contact lens and other autogenous grafts such as conjunctiva, cartilage, mucous membrane, fascia, and tibial periosteum as well as homologous scleral and lamellar patch grafts were not used. In some patients such grafts were not employed because they were too bulky or did not contain epithelium.9" SURGICAL TECHNIQUE In all 10 patients, split-thickness dermal grafts were harvested from the outer aspect of the thigh using a power-driven Brown dermatome (Fig 1).

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“…Using autogenous periosteum as a graft has several advantages: harvesting and vascularization is easy [3], it has an excellent tensile strength, provides ample tectile support, it is not susceptible to immunological rejection and it is easily available [4]. On the other hand, there are some disadvantages: periosteum provides an irregular surface, thus covering the graft with a conjunctival flap is needed [3].…”

Section: Introductionmentioning

confidence: 99%