Successful Free Bilamellar Eyelid Grafts for the Repair of Upper and Lower Eyelid Defects in Patients and Laser Speckle Contrast Imaging of Revascularization

Abstract

Purpose: It is generally believed that large eyelid defects must be repaired using a vascularized flap for 1 lamella, while the other can be a free graft. Recent studies indicate that the pedicle of a tarsoconjunctival flap does not contribute to blood perfusion. The purpose of this study was to explore whether large eyelid defects can be repaired using a free bilamellar eyelid autograft alone. Methods: Ten large upper and lower eyelid defects resulting from tumor excision were reconstructed using bilamellar grafts harvested from the contralateral or opposing eyelid. Revascularization of the flap was monitored during healing using laser speckle contrast imaging, and the surgical outcome was assessed. Results: The functional and cosmetic results were excellent. All grafts survived and there was no tissue necrosis. Only 1 patient underwent revision after 4 days as the sutures came loose. Two patients developed minimal ectropion but needed no reoperation. All patients were satisfied with the surgical results. Perfusion monitoring showed that the grafts were gradually revascularized, exhibiting 50% perfusion after 4 weeks and 90% perfusion after 8 weeks. Conclusions: A free bilamellar eyelid graft appears to be an excellent alternative to the tarsoconjunctival flap procedure in the reconstruction of both upper and lower eyelid defects, especially in patients who cannot tolerate visual axis occlusion or the 2-stage procedure of the conventional staged flap procedure.

Transmissive-detected laser speckle contrast imaging for blood flow monitoring in thick tissue: from Monte Carlo simulation to experimental demonstration

“…However, without such “windows”, the light should penetrate the upper tissue layer above the deep blood vessel layer, during which path it constantly decays, making the strength of static speckle in the upper layer much greater than that of dynamic speckle signal in the deep targeted layer, leading to the extremely decreased contrast and resolution of conventional LSCI, or even making the blood flow undetectable 15 . Moreover, even with the assistance of skull and skin windows, conventional LSCI is still only able to provide acceptable resolution in the superficial layers, while even the body parts of mice are often hundreds of microns or even millimeters thick, making it barely possible to obtain comprehensive information using such a technique 16 – 18 .…”

Two Advancement Flaps for Eyelid Margin Reconstruction of Small and Medium Defects and a Novel Design to Reduce Ocular Injury

“…For VSS, 0-3 was none; 4-6 was slight; 7-9 was moderate; and 10-13 was severe. 6 Each patient's total score was classed as excellent (0-10), good (11)(12)(13)(14)(15)(16)(17)(18)(19)(20), or poor (21)(22)(23)(24)(25)(26)(27)(28)(29)(30). A patient satisfaction survey was conducted, with possible ratings of not satisfied, slightly satisfied, moderately satisfied, or very satisfied.…”

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

“…The tarsoconjunctival grafts taken from healthy eyelids are the gold standard tissue for posterior lamellar reconstruction [ 50 ] and have been used to repair defects of up to 75% of the eyelid length [ 51 , 52 ]. Typically, the size of the donor tarsoconjunctival graft ranges from 4 to 5 mm vertically and 8–16 mm horizontally, and preservation of at least 4 mm of the tarsus is recommended to avoid complications.…”