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Hard palate and free tarsal grafts as posterior lamella substitutes in upper lid surgery.

Leibovitch I, Malhotra R, Selva D

Oculoplastic & Orbital Division, Department of Ophthalmology & Visual Sciences, Royal Adelaide Hospital, University of Adelaide, Adelaide, South Australia, Australia. leiboigal5@yahoo.com.au

OBJECTIVES: To present the surgical outcomes and postoperative complications in a series of patients who underwent upper lid surgery using autogenous hard palate grafts (HPGs) or free tarsal grafts (FTGs) as posterior lamella replacement material. DESIGN: Retrospective, comparative, interventional case series. PATIENTS: Thirty-one consecutive patients who were operated in 2 oculoplastics centers between July 2000 and January 2005. METHODS: All patients' clinical records were reviewed. MAIN OUTCOME MEASURES: Postoperative upper eyelid contour and viability, ocular discomfort, keratopathy, and corneal edema, as well as assessment for donor site complications and final graft dimensions. RESULTS: There were 31 patients who underwent upper lid surgery (15 HPGs, 16 FTGs). The complications in the HPG group included corneal edema or transient keratopathy (13.3%), partial graft dehiscence (13.3%), upper lid retraction (13.3%), and necrosis of the overlying skin flap (6.7%). There were no significant postoperative complications in the FTG group during a mean follow-up period of 13.5+/-5 months. Donor site complications included 2 cases of mild upper lid retraction and central peaking. There were an average of 17% decrease in FTG vertical height and a 24% decrease in HPG vertical height during the follow-up period. CONCLUSION: Hard palate grafts may be associated with a higher rate of complications in upper lid surgery relative to FTGs, although most complications are temporary. Graft contraction could be reduced by oversizing.

Published 3 March 2006 in Ophthalmology, 113(3): 489-96.
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