Full thickness skin graft in repair of cicatricial eyelid disfigurement

Abstract

Proper eyelid closure and a normal blink reflex are essential to maintaining a stable tear film and a healthy corneal surface. Cicatricial ectropion is an acquired ectropion characterized by scarring and shortening of the anterior lamella, so that vertical tightness of the eyelid skin which pulls the eyelid margin away from the globe. It can result from different reasons as trauma, secondary scarring, chemical burn, surgery for floor fracture, inferior blepharoplasty. Symptoms of cicatricial ectropion include tearing, ocular irritation and cosmetic disturbance also chronic irritation, burning, stinging, foreign body sensation, mucous discharge, pain, photophobia and blurry vision. Cicatricial skin changes are assessed carefully to differentiate different types of ectropion. Slit lamp examination can reveal signs of exposure keratopathy as a complication. As punctate epithelial changes, epithelial breakdown, stromal melting, secondary infection. Surgical treatment for eyelid ectropion is based on correct identification of the underlying pathogenetic factors. A prospective case study was conducted included 10 patients with cicatricial eyelid disfigurement causing ectropion, had full thickness skin graft as a treatment. Follow up and assessment of the eyelid condition for detection of any complication and dealing with it. The parameters which recorded include : patient name, age, sex, indication for full thickness skin graft, donor site, recipient site and complications. Preoperative evaluation included careful history taking. Patient evaluation included external examination for lagophthalmos, slit lamp examination, donor site and the surrounding periorbital tissue. Statistical analysis of the collected data revealed: recipient site complications whether early: 60.0% had no early postoperative host site complications, 20.0% had infection, and 2 (20.0%) had partial graft failure. Late: 40.0% showed no complications, 20.0% had graft hypertrophy followed by recurrent cicatricial ectropion, , 10.0% had graft hypertrophy, 10.0% had recurrent ectropion, 10.0% had lagophathalmos 10.0% had graft contracture followed by recurrent ectropion. Follow up of the patients revealed Success criteria (secondary outcome measures) included: Eyelid position assessed and classified as; good in 60.0% or inadequate in 40.0%. Colour match, the degree of colour match between the full thickness skin graft and the surrounding skin recorded as either hypopigmented in 20.0%, adequate in 50.0%, or good in 30.0%. Condition of the cornea assessed and classified as; clear cornea in 90.0% or complications of exposure keratitis in 10.0%. Scar of the donor site, assessed and classified as good cosmetic appearance in 100.0%. Relief of the symptoms as expressed by the patient as; relief of symptoms in 50.0% or persistence of symptoms in 50.0%.