Reconstruction of Eyelid Posterior Lamella Using Deep Fascia: An Experimental Study in Rabbits

Abstract

Eyelid reconstruction may be necessary after eyelid burns, trauma, or tumor resections. The limited availability of tarsoconjunctival tissue has led to the use of various grafts, including hard palate mucosa, lip mucosa, cartilage grafts, and acellular dermal matrix. This study aimed to evaluate the experimental use of deep fascia grafts in eyelid reconstruction, hypothesizing that they can provide adequate structural and physiological support when covered by conjunctival epithelium. An experimental study was conducted on 16 rabbits, divided into two groups: a graft group (n=8) and a control group (n=8). A 1x1 cm defect was created in the posterior lamella of the lower eyelid in all animals. The defect in the graft group was repaired with a deep fascia graft from the anterior thigh, while defects in the control group were left to secondary healing. Macroscopic outcomes included hematoma, eye irritation, conjunctivitis, and scleral show. Microscopic outcomes included inflammation, fibrosis, vascularization, conjunctival epithelialization, and goblet cell presence. Macroscopic changes were monitored for one month. Microscopic evaluations of harvested tissues were performed by a pathologist, and statistical analyses determined significance. In the graft group, no scleral show was observed, while it was evident in the control group. Microscopic examination revealed statistically significant differences in inflammation and vascularization between groups. The deep fascia graft demonstrated sufficient support, compatibility with conjunctival epithelium, and absence of ocular irritation. These results suggest that deep fascia may serve as a viable alternative for posterior lamella reconstruction.

Keywords

• graft
• posterior lamella
• reconstructive surgery

Derin Fasya Kullanılarak Göz Kapağı Posterior Lamellasının Rekonstrüksiyonu: Tavşanlarda Deneysel Bir Çalışma

Abstract

Göz kapağı rekonstrüksiyonu, yanıklar, travmalar veya tümör rezeksiyonları sonrasında gerekli olabilir. Tarsokonjonktival dokunun sınırlı bulunabilirliği, sert damak mukozası, dudak mukozası, kıkırdak greftleri ve aselüler dermal matriks gibi çeşitli greftlerin kullanımına yol açmıştır. Bu çalışma, derin fasya greftlerinin göz kapağı rekonstrüksiyonunda deneysel olarak kullanımını değerlendirmeyi ve konjonktival epitel ile kaplandığında yeterli yapısal ve fizyolojik desteği sağlayabileceği hipotezini test etmeyi amaçlamıştır. Çalışmada 16 tavşan kullanılarak deneysel bir model oluşturulmuş, hayvanlar greft grubu (n=8) ve kontrol grubu (n=8) olmak üzere ikiye ayrılmıştır. Tüm hayvanların alt göz kapağının posterior lamellasında 1x1 cm boyutunda defekt oluşturulmuştur. Greft grubundaki defektler, ön uyluk bölgesinden alınan derin fasya grefti ile onarılırken, kontrol grubundaki defektler sekonder iyileşmeye bırakılmıştır. Makroskopik sonuçlar arasında hematom, göz irritasyonu, konjonktivit ve skleral show değerlendirilmiştir. Mikroskopik değerlendirmeler ise inflamasyon, fibrozis, vaskülarizasyon, konjonktival epitelizasyon ve goblet hücre varlığı parametrelerini içermiştir. Makroskopik değişiklikler bir ay boyunca izlenmiş, histopatolojik değerlendirmeler patolog tarafından yapılmış ve istatistiksel analizlerle anlamlılık değerlendirilmiştir. Greft grubunda skleral show izlenmezken, kontrol grubunda belirgin şekilde gözlenmiştir. Mikroskopik incelemelerde inflamasyon ve vaskülarizasyon düzeylerinde gruplar arasında istatistiksel olarak anlamlı fark saptanmıştır. Derin fasya grefti yeterli yapısal destek sağlamış, konjonktival epitel ile uyumluluk göstermiş ve oküler irritasyona yol açmamıştır. Bu sonuçlar, derin fasyanın posterior lamella rekonstrüksiyonu için uygulanabilir bir alternatif olabileceğini göstermektedir.

Keywords

• greft
• posterior lamella
• rekonstrüktif cerrahi

References

1. 1. Mukit M, Anbar F, Dadireddy K, Konofaos P. Eyelid Reconstruction: An Algorithm Based on Defect Location. J Craniofac Surg. 2022 May;33(3):821–6.
2. 2. Yamamoto N, Ogi H, Yanagibayashi S, Yoshida R, Takikawa M, Nishijima A, et al. Eyelid Reconstruction Using Oral Mucosa and Ear Cartilage Strips as Sandwich Grafting. Plast Reconstr Surg - Glob Open. 2017 Apr;5(4):e1301.
3. 3. Ito R, Fujiwara M, Nagasako R. Hard Palate Mucoperiosteal Graft for Posterior Lamellar Reconstruction of the Upper Eyelid. J Craniofac Surg. 2007 May;18(3):684–90.
4. 4. Jordan DR, McDonald H, Addison DJ, Anderson RL. Irradiated Homologous Aorta in Eyelid Reconstruction Part 1. Ophthalmic Plast Reconstr Surg. 1994 Jun;10(2):75–9.
5. 5. Jiaqi C, Zheng W, Jianjun G. Eyelid reconstruction with acellular human dermal allograft after chemical and thermal burns. Burns. 2006 Mar;32(2):208–11.
6. 6. Stecco C, Tiengo C, Stecco A, Porzionato A, Macchi V, Stern R, et al. Fascia redefined: anatomical features and technical relevance in fascial flap surgery. Surg Radiol Anat. 2013 Jul 25;35(5):369–76.
7. 7. Fin A, De Biasio F, Lanzetta P, Mura S, Tarantini A, Parodi PC. Posterior lamellar reconstruction: a comprehensive review of the literature. Orbit. 2019 Jan 2;38(1):51–66.
8. 8. Yan Y, Ji Q, Fu R, Liu C, Yang J, Yin X, et al. Biomaterials and tissue engineering strategies for posterior lamellar eyelid reconstruction: Replacement or regeneration? Bioeng Transl Med. 2023 Jul 15;8(4).

9. 9. Toft PB. Reconstruction of large upper eyelid defects with a free tarsal plate graft and a myocutaneous pedicle flap plus a free skin graft. Orbit [Internet]. 2016 Jan 2 [cited 2024 Dec 30];35(1):1–5. Available from: https://www.tandfonline.com/doi/abs/10.3109/01676830.2015.1078372
10. 10. Vimont T, Arnaud D, Rouffet A, Giot JP, Florczak AS, Rousseau P. Hübner’s tarsomarginal grafts in eyelid reconstruction: 94 cases. J Stomatol Oral Maxillofac Surg. 2018 Sep 1;119(4):268–73.
11. 11. Yildirim S, Gideroğlu K, Aköz T. Application of Helical Composite Sandwich Graft for Eyelid Reconstruction. Ophthalmic Plast Reconstr Surg. 2002 Jul;18(4):295–300.
12. 12. Suga H, Eto H, Shigeura T, Inoue K, Aoi N, Kato H, et al. IFATS Collection: Fibroblast Growth Factor-2-Induced Hepatocyte Growth Factor Secretion by Adipose-Derived Stromal Cells Inhibits Postinjury Fibrogenesis Through a c-Jun N-Terminal Kinase-Dependent Mechanism. Stem Cells. 2009 Jan 1;27(1):238–49.
13. 13. Nigro MVAS, Friedhofer H, Natalino RJM, Ferreira MC. Comparative Analysis of the Influence of Perichondrium on Conjunctival Epithelialization on Conchal Cartilage Grafts in Eyelid Reconstruction: Experimental Study in Rabbits. Plast Reconstr Surg. 2009 Jan;123(1):55–63.
14. 14. Lemaître S, Lévy-Gabriel C, Desjardins L, González-Candial M, Gardrat S, Dendale R, et al. Outcomes after surgical resection of lower eyelid tumors and reconstruction using a nasal chondromucosal graft and an upper eyelid myocutaneous flap. J Fr Ophtalmol. 2018 May 1;41(5):412–20.
15. 15. Grixti A, Malhotra R. Oral mucosa grafting in periorbital reconstruction. Orbit. 2018 Nov 2;37(6):411–28.
16. 16. Weinberg DA, Tham V, Hardin N, Antley C, Cohen AJ, Hunt K, et al. Eyelid Mucous Membrane Grafts: A Histologic Study of Hard Palate, Nasal Turbinate, and Buccal Mucosal Grafts. Ophthalmic Plast Reconstr Surg. 2007 May;23(3):211–6.
17. 17. Baltu Y. Posterior Lamellar Reconstruction of the Lower Eyelid With a Gingivoalveolar Mucosal Graft. J Craniofac Surg. 2018 Jun;29(4):1017–9.
18. 18. Pelletier CR, Jordan DR, Brownstein S, Li S. An Unusual Complication Associated With Hard Palate Mucosal Grafts. Ophthalmic Plast Reconstr Surg. 1998 Jul;14(4):256–60.
19. 19. Vahdani K, Siapno D Lou, Lee JH, Woo KI, Kim Y-D. Long-Term Outcomes of Acellular Dermal Allograft as a Tarsal Substitute in the Reconstruction of Extensive Eyelid Defects. J Craniofac Surg. 2018 Jul;29(5):1327–31.
20. 20. Gu J, Zhai J, Chen J. The use of acellular human dermis composite graft for upper eyelid reconstruction in ocular injury. J Trauma Acute Care Surg. 2012 Jan;72(1):288–92.
21. 21. Shorr N, Perry JD, Goldberg RA, Hoenig J, Shorr J. The Safety and Applications of Acellular Human Dermal Allograft in Ophthalmic Plastic and Reconstructive Surgery. Ophthal Plast Reconstr Surg. 2000 May;16(3):223–30.
22. 22. Lee YJ, Khwarg SI. Polytetrafluoroethylene as a Spacer Graft for the Correction of Lower Eyelid Retraction. Korean J Ophthalmol. 2005;19(4):247.