Neena M Peter1, Bimal Kumar. 1. Milton Keynes Hospital, Milton Keynes, United Kingdom. neenapeter@yahoo.co.uk
Abstract
BACKGROUND: Reconstruction of a full-thickness lower eyelid defect is not an uncommon procedure and requires repair of both the anterior and posterior lamella. The modified Hughes procedure is commonly used for large defects, however this requires a second procedure and since the flap must be left in place for at least 3 weeks prior to the second-stage separation, it is not suitable for patients with only eyes or of amblyogenic age. In such situations, a free tarsoconjunctival graft from the opposite upper eyelid or a mucoperiosteal graft from the hard palate is more appropriate. These have the advantage of being autologous tissue with excellent recipient tolerance, however, they are not without drawbacks, including donor site scarring, limited availability and prolonged operating time. In order to avoid donor-site morbidity, several substitutes on the market can be used to replace autologous grafts. Permacol is a relatively new biomaterial made from acellular cross-linked porcine dermal collagen with a structural architecture very similar to that of human dermis. METHODS: The authors present the first report of the use of Permacol to replace tarsus in the reconstruction of a full-thickness lower eyelid defect. RESULTS: Permacol seems to be far superior to other commercially available tissue substitutes because of its increased tensile strength, rigidity, durability, predictability of structure and robust behaviour. It is well incorporated by the body, and it serves as an excellent matrix for tissue ingrowth. CONCLUSION: We feel it is a very good autologous graft substitute in eyelid reconstructive surgery and achieved satisfactory functional and aesthetic results.
BACKGROUND: Reconstruction of a full-thickness lower eyelid defect is not an uncommon procedure and requires repair of both the anterior and posterior lamella. The modified Hughes procedure is commonly used for large defects, however this requires a second procedure and since the flap must be left in place for at least 3 weeks prior to the second-stage separation, it is not suitable for patients with only eyes or of amblyogenic age. In such situations, a free tarsoconjunctival graft from the opposite upper eyelid or a mucoperiosteal graft from the hard palate is more appropriate. These have the advantage of being autologous tissue with excellent recipient tolerance, however, they are not without drawbacks, including donor site scarring, limited availability and prolonged operating time. In order to avoid donor-site morbidity, several substitutes on the market can be used to replace autologous grafts. Permacol is a relatively new biomaterial made from acellular cross-linked porcine dermal collagen with a structural architecture very similar to that of human dermis. METHODS: The authors present the first report of the use of Permacol to replace tarsus in the reconstruction of a full-thickness lower eyelid defect. RESULTS: Permacol seems to be far superior to other commercially available tissue substitutes because of its increased tensile strength, rigidity, durability, predictability of structure and robust behaviour. It is well incorporated by the body, and it serves as an excellent matrix for tissue ingrowth. CONCLUSION: We feel it is a very good autologous graft substitute in eyelid reconstructive surgery and achieved satisfactory functional and aesthetic results.