Reconstruction of total upper eyelid with prefabricated capsule-lined advancement flaps.

BACKGROUND: A total upper eyelid defect is a rare problem that may result from tumor excision, trauma, or burns. Reconstruction of a total upper eyelid defect involves the reconstruction of 2 fundamental elements: anterior and posterior lamellae. Because an expander capsule looks like the palpebral conjunctiva with a moist, smooth, white glistening appearance, its use was investigated in the repair of total upper eyelid defects in rabbits.

METHODS: Sixty-six tissue expanders with the autogeneic conchal chondro-grafts were implanted into the foreheads of 66 rabbits. After 6 to 8 weeks, the sandwich-prefabricated advancement flaps were designed to reconstruct rectangular excisions of the upper eyelid. The cartilage was preliminarily inserted in a flap, formed by tissue expansion, and then transferred to an upper eyelid defect in the rabbit. Histopathology was evaluated at 3 days, 1 week, 2 weeks, 1 month, 2 months, and 4 months after reconstruction. The upper palpebral length was measured after 4 months of reconstruction as a 1-dimension reference point of flap contracture.

RESULTS: No edema, congestion, infection, corneal damage, or necrosis were observed during the reconstructions. Histopathologic studies revealed that the long-term capsule had a normal conjunctiva-like appearance with a stratified columnar epithelium. The average shortening, measured as the length between inner to outer canthal folds, was inconspicuous.

CONCLUSIONS: The expander capsule has the potential to act as an effective posterior lamellar substitute of eyelid in a rabbit model. Further studies should be undertaken to see if this represents a good model for a potential human clinical application.