The palatal mucosal graft: The adequate posterior lamellar reconstruction in extensive full-thickness eyelid reconstruction

• Published in: Annales de chirurgie plastique et esthétique 2020-02, Vol.65 (1), p.61-69
• Main Authors: Hendriks, S., Bruant-Rodier, C., Lupon, E., Zink, S., Bodin, F., Dissaux, C.
• Format: Article
• Language: English
• Subjects: Eyelid Neoplasms - surgery; Eyelid reconstruction; Eyelids - surgery; Full-thickness eyelid reconstruction; Graft Survival - physiology; Greffe fibromuqueuse; Greffe palatine; Lambeau musculocutané palpébral supérieur; Life Sciences; Mouth Mucosa - transplantation; Mucosal graft; Orbicularis myocutaneous flap; Palatal graft; Palatal Muscles - transplantation; Reconstruction de paupières; Reconstruction des paupières pleine épaisseur; Reconstructive Surgical Procedures - methods; Retrospective Studies; Surgical Flaps
• ISSN: 0294-1260; 1768-319X
• DOI: 10.1016/j.anplas.2019.01.007

Full-thickness eyelid defects exceeding 25% of the eyelid width should benefit from a skillful, immediate and simultaneous reconstruction of two layers; anterior and posterior lamella. In this article, we recall, through an original series of cases, the possibility of using a palatal fibromucosal graft during the reconstruction of the posterior lamella as well as the modalities of its optimal use. Retrospective study, including 8 patients with an extensive full-thickness eyelid defect affecting more than half of the upper and/or lower eyelid, after tumor excisions. 4 cases were involved in lower eyelid reconstruction, 2 in upper one and 2 in both. Posterior lamella was reconstructed using a palatal mucosal graft. Anterior lamella was reconstructed using different flaps: Esser-Mustardé flap, medially and laterally based orbicularis oculi myocutaneous flap, Tripier and orbitonasolabial flaps. Mean follow-up was 12.75 months. The survival rate of grafts and flaps was excellent with only one flap border necrosis. The donor site healed in an average time of 3 weeks. Functional recovery, complete eye closure and opening, was obtained in all cases. Lining, texture and color was considered satisfactory in all cases. The palatal mucosal graft provides a good and lasting structural support to the eyelid, which is essential for the inferior eyelid, especially when combined with a flap. Slight overcorrection is recommended. Les pertes de substances palpébrales transfixiantes dépassant 25% de la largeur de la paupière doivent bénéficier d’une reconstruction immédiate et précise des deux lamelles la composant, antérieure et postérieure. Nous rappelons dans cet article, par une série originale de cas, la possibilité d’utiliser une greffe de fibromuqueuse palatine lors des reconstructions de la lamelle postérieure ainsi que les modalités de son utilisation. Cette étude rétrospective décrit 8 patients présentant une perte de substance transfixiante de paupière, touchant plus de la moitié de la paupière supérieure et/ou inférieure, après excision tumorale. 4 cas concernaient la reconstruction de la paupière inférieure, 2 la paupière supérieure et 2 les deux. La lamelle postérieure a toujours été reconstruite à l’aide d’un greffon de fibromuqueuse palatine, la lamelle antérieure par différents lambeaux : lambeau d’Esser-Mustardé, lambeaux musculocutanés palpébraux supérieurs unipédiculés, lambeaux de Tripier et orbitonaso-génien. Le suivi moyen était de 12,75 mois. Le taux d