Copyright ©The Author(s) 2022.
World J Transplant. Jul 18, 2022; 12(7): 175-183
Published online Jul 18, 2022. doi: 10.5500/wjt.v12.i7.175
Table 1 Studies in literature regarding reconstructive eyelid surgery
Type of tissue transplant
GraftsBilamellar reconstructionSkin graft + tarsoconjunctival graft with orbicularis oculi muscle advancementDoxanas[11], 1986; Kakizaki et al[10], 2009Orbital part muscle mobilization allows full thickness eyelid reconstruction using two grafts due to its vascular support
Skin graft + tarsal graftBortz et al[12], 2020Reconstruction of lower eyelid defects with a free tarsal graft and overlying free skin graft resulted in an acceptable functional and aesthetic lower eyelid suggesting that retention of or provision of vascular support in either the anterior or posterior lamella may not be necessary
Anterior lamellaSkin graftAlghoul et al[9], 2013Anterior lamellar defects can be reconstructed with a full-thickness skin graft. Split-thickness skin grafts should not be used
Skin graftShorr et al[14], 2003Upper eyelid skin grafting can be performed with good cosmetic results to address corneal decompensation in patients who have acquired lagophthalmos from anterior lamellar insufficiency
Posterior lamellaTarsoconjunctival graftHawes et al[17], 2011Essential component of eyelid reconstruction as it provides an anatomically similar tissue for the inner layer of reconstructed eyelids. Patients receiving a free tarsoconjunctival graft were less likely to require surgery to repair eyelid margin erythema than those receiving a Hughes tarsoconjunctival flap
Yazici et al[23], 2020Lateral periorbital bilobed flap with tarsoconjunctival graft can be a good alternative for the single-stage reconstruction of large upper eyelid defects
Bengoa-González et al[24], 2019Reconstruction of upper eyelid defects secondary to malignant tumors with a newly modified Cutler-Beard technique with tarsoconjunctival graft gives stability to the new upper eyelid, avoiding retraction caused by scarring
Hard-palate mucoperiostealYue et al[26], 2020; Ito et al[27], 2007HPM may be considered the optimal choice for reconstructing the posterior lamella of the eyelids because it has similar histological composition and texture to the tarsoconjunctiva
Hendriks et al[28], 2020The use in upper eyelid reconstruction is controversial because hard-palate mucosa is composed of keratinized, stratified squamous epithelium, which can irritate the cornea. Despite this, excellent results were reported for its use in upper eyelid posterior lamellar reconstruction
Chondromucosal graftYamamoto et al[33], 2017Ear cartilage is useful because it is easy to harvest and fabricate, has suitable flexibility, and provides adequate support. Chondromucosal grafts from the nasal septum consist of highly supportable tissue. It lacks softness and flexibility, and harvesting is limited
Suga et al[34], 2016Ear cartilage fits well to bulbar surface. It has lower complication rate, while in the nose septal perforation and more bleeding can occur
Hendriks et al[28], 2020The use of alar or triangular cartilage provides a thinner but smaller sized sample, with good adaptability in eyelid reconstruction but raised the problem of donor site morbidity
Scapha chondrocutaneous graftUemura et al[36], 2016The scapha cartilage graft with small skin, round and soft with a shape similar to that of the lower lid, affords a good fit to the eye globe
Dermis fat graftKuzmanović Elabjer et al[39], 2018Provides stiffness, additional surface area, and a scaffold. Helps with vascularization and decreases fat tissue atrophy. It can be flat or domed
Venous graftBarbera et al[40], 2008VGs obtained by propulsive venous vessels are the most suitable for this reconstruction because of their thinness, texture, and anatomical structure
Tomassini et al[41], 2012By properties of elasticity, smoothness, and concavity, the VG conforms to the globe without inducing a chronic inflammatory reaction on the bulbar conjunctiva or on the cornea
Scevola et al[42], 2015Safe, fast, and easily reproducible compared with chondroseptal graft
Galea or pericranium graftIbáñez-Flores et al[43], 2019Pericranial graft provides enough tissue to cover large defects, with an appropriate volume and a non-painful postoperative period
Buccal mucosa graftGrixti and Malhotra[44], 2018; Jin and Cao[45], 2021It lacks structural integrity. It is too weak and small to support the lower eyelid, shrinking substantially during the postoperative period, so it should be used in combination with cartilage
FlapsBilamellar reconstructionNeurovascular free flap from the first web space of the footChait et al[46], 1980
Free flap based on the second metacarpal arteryYap et al[47], 1997
Free dorsalis pedis flapThai et al[48], 1999Free flap used for outer lamella and conjunctival flap for inner lamella
Free forearm flapKushima et al[49], 2003Entire upper eyelid reconstruction and a hard palate graft for the posterior one
Ghadiali et al[50], 2016Upper and lower eyelid total reconstruction where an extensive tissue loss of the ipsilateral forehead and temple. Tarsal plate of the eyelids was rebuilt by palmaris tenon grafts
Iwanaga et al[51], 20192 cases of functional upper eyelid defect reconstruction. They used a free flap elevated with palmaris longus tenon split into two strips: One fixed to the frontalis muscle to achieve the opening function and the second to the medial palpebral ligament and the lateral orbicularis muscle to achieve the closing function
ALT flapRubino et al[52], 2008Upper and lower eyelid unilateral full thickness reconstruction with ALT free flap in a patient with no available adjacent tissues, involved in extended burns, and no possibility of using RFF