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World J Transplant. Jul 18, 2022; 12(7): 175-183
Published online Jul 18, 2022. doi: 10.5500/wjt.v12.i7.175
How and when of eyelid reconstruction using autologous transplantation
Giovanni Miotti, Marco Zeppieri, Agostino Rodda, Carlo Salati, Pier Camillo Parodi
Giovanni Miotti, Pier Camillo Parodi, Department of Plastic Surgery, University Hospital of Udine, Udine 33100, Italy
Giovanni Miotti, Agostino Rodda, Department of Medical, Surgical and Health Sciences, Plastic and Reconstructive Surgery Unit, University of Trieste, Trieste 34123, Italy
Marco Zeppieri, Carlo Salati, Department of Ophthalmology, University Hospital of Udine, Udine 33100, Italy
Author contributions: Miotti G and Zeppieri M wrote the outline; Miotti G and Rodda A did the research of the manuscript; Miotti G, Zeppieri M, Rodda A, Salati C, and Parodi PC assisted in the writing of the paper; Zeppieri M was responsible for the conception and design of the study and completed the English and scientific editing; Salati C and Parodi PC assisted in the editing and making critical revisions of the manuscript; All authors provided the final approval of the version of the article.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Marco Zeppieri, BSc, MD, PhD, Doctor, Department of Ophthalmology, University Hospital of Udine, p.le SM Misericordia, Udine 33100, Italy.
Received: December 29, 2021
Peer-review started: December 29, 2021
First decision: April 19, 2022
Revised: April 20, 2022
Accepted: June 18, 2022
Article in press: June 18, 2022
Published online: July 18, 2022

Reconstructive surgery of the eyelid after tumor excision, trauma or other causes can be challenging, especially due to the complexities of the anatomic structures and to the necessity of both functional and aesthetic successful outcomes. The aim of this minireview was to investigate the use of tissue transplantation in eyelid reconstruction. Surgical procedures are various, based on the use of both flaps, pedicled or free, and grafts, in order to guarantee adequate tissue reconstruction and blood supply, which are necessary for correct healing. Common techniques normally include the use of local tissues, combining non-vascularized grafts with a vascularized flap for the two lamellae repair, to attempt a reconstruction similar to the original anatomy. When defects are too wide, vast, deep, and complex or when no adjacent healthy tissues are available, distant area tissues need to be recruited as free flaps or grafts and paired with mucosal layer reconstruction. With regards to the anterior lamella, full thickness skin grafts are commonly preferred. With regards to the reconstruction of posterior lamella, there are different graft options, which include conjunctival or tarsoconjunctival, mucosal or palatal or cartilaginous grafts usually combined with local flaps. Free flap transplantation, normally reserved for rare select cases, include the use of the radial forearm and anterolateral flaps combined with mucosal grafts, which are surgical options currently reported in the literature.

Keywords: Eyelid reconstruction, Graft transplantation, Flap transplantation, Eyelid lamella grafts, Cartilage grafts, Dermis grafts, Mucosa grafts

Core Tip: Transplantation tends to be a viable option in eyelid reconstruction surgery. The most commonly used technique involves the use of grafts for the reconstruction of one or both eyelid structures. The use of free flaps are seldom used and are reserved for cases of extensive tissue lost. In these cases, favorable flaps considered are those that are anatomically thin and pliable.