Venous Graft for Full-thickness Palpebral Reconstruction

Abstract

Summary:Full-thickness palpebral reconstruction is a challenge for most surgeons. The complex structures composing the eyelid must be reconstructed with care both for functional and cosmetic reasons. It is possible to find in literature different methods to reconstruct either the anterior or posterior lamella, based on graft or flaps. Most patients involved in this kind of surgery are elderly. It is important to use easy and fast procedures to minimize the length of the operation and its complications. In our department, we used to reconstruct the anterior lamella by means of a Tenzel or a Mustardé flap, whereas for the posterior lamella, we previously utilized a chondromucosal graft, harvested from nasal septum. Thus, these procedures required general anesthesia and long operatory time. We started using a vein graft for the posterior lamella. In this article, we present a series of 9 patients who underwent complex palpebral reconstruction for oncological reasons. In 5 patients (group A), we reconstructed the tarsoconjunctival layer by a chondromucosal graft, whereas in 4 patients (group B), we used a propulsive vein graft. The follow-up was from 10 to 20 months. The patient satisfaction was high, and we had no relapse in the series. In group A, we had more complications, including ectropion and septal perforations, whereas in group B, the operation was faster and we noted minor complications. In conclusion, the use of a propulsive vein to reconstruct the tarsoconjunctival layer was a reliable, safe, and fast procedure that can be considered in complex palpebral reconstructions.

The Use of Composite Flaps in the Management of Large Full-Thickness Defects of the Lower Eyelid

“… 13 Some defects can be closed only with skin sutures, but deeper defects and those under tension require layered closure. 10 , 11 , 16 , 19 , 20 The use of a 1-step procedure such as the free tarsoconjunctival graft and flap would inevitably cause eyelid retraction. 21 , 22 The Mustarde flap as well as the modified rotational advancement cheek flap can wrap a large defect consisting of as much as 75% of eyelid by providing a more physiological structure and little disturbance of the donor site.…”

How and when of eyelid reconstruction using autologous transplantation

“…Moreover, due to the properties of elasticity, smoothness, and concavity, the venous graft conforms to the globe without inducing a chronic inflammatory reaction on the bulbar conjunctiva or on the cornea[ 41 ]. Scevola et al [ 42 ] showed that VG is a good technique for palpebral reconstruction because it is safe, fast, and easily reproducible when compared with a chondroseptal graft.…”