Case report of Wolfe grafting for the management of bilateral cicatricial eyelid ectropion following severe burn injuries

Abstract

IntroductionEye lid reconstruction followed by severe, extensive body and facial burns represents a surgical challenge due to difficulties to obtain proper, healthy skin graft, tissue ischemia and necrosis.Presentation of caseWe present a reconstructive lid surgery of cicatricial bilateral lower eyelid ectropion in a case of 31-year-old man who sustained thermal injuries, affecting more than 60% of total body surface area, causing severe, deep dermal burns. Reconstruction was made using the technique of skin cantus-to-cantus incision, contracture release, orbicularis liberation and lid elevation; and oversizing free full-thickness skin graft (FTSG) (Wolfe technique) from the left inguinal region, as the only healthy skin on the entire body surface. Residual lower left lid laxity was addressed by pentagonal wedge resection, not interrupting marginal arcade vessels, thus minimizing ischemia.DiscussionMethod of choice of the graft type has been much debated question; however, significantly less reoccurrence rate of ectropion was observed using FTSG. Time of grafting should be balanced to avoid excess granulation and, thus scaring caused by delayed grafting time, or poor graft adherence caused by premature grafting. An interruption of the marginal arcade vessels should not be performed due to already severe ischemic process and increased risk for lid necrosis.ConclusionMajor issues when addressing cicatricial ectropion followed by severe burns are: right donor site selection, appropriate graft thickness with the least possible disturbance of the affected place vascularisation, followed by immediate grafting after debridement of scaring and unhealthy tissue, with generous preservation of the orbicularis muscle.

The Lateral Orbital Thickening and the Lateral Brow Thickening: A New Choice for the Lower Eyelid Suspension

“…However, the shortcomings of pigmentation and patch-like appearance have not been well resolved 15. The main complications after lower eyelid repair include lower eyelid ectropion and retraction 16–22. The incidence rate of the lower eyelid ectropion was ∼15%-20%, according to a passage in 2019 23.…”

“…15 The main complications after lower eyelid repair include lower eyelid ectropion and retraction. [16][17][18][19][20][21][22] The incidence rate of the lower eyelid ectropion was ∼15%-20%, according to a passage in 2019. 23 It may be related to 2 factors, one is the insufficient tissue replacement, and the other is the failure to maintain a long-term force balance.…”

Management of facial burns: an update

“…This can also be combined with lacrimal stenting. The choice of tissue for resurfacing the eyelid burn wound still remains a full thickness skin graft (FTSG), conjunctival flap or graft, mucosal graft, or split thickness skin graft (STSG) with preference of one over the other still debatable and very dependent on the nature and severity of the injury [36].…”