Full-thickness eyelid defects repaired with venous wall graft

The authors of this study describe their use of a new material, a venous wall graft taken from the forearm or leg, to reconstruct tarsus-conjunctival defects. They prefer using this new autologous material due to ease of harvesting, functional and cosmetic outcome and paucity of donor site complications. It may be best-suited for the lower eyelid because the size and thickness of the available vein wall may be limited.

The study reports on the cases of seven patients selected for venous wall self-graft. Patients were eligible if their cancer required full-thickness excision and the surgical defect width was larger than 30 percent of the original eyelid margin. Five patients were diagnosed with basal cell carcinoma and two with adenocarcinoma on the conjunctiva. Excisions were made on the lower eyelid only in six cases.

The authors explained that propulsive venous vessels are preferable for tarsus-conjunctival reconstruction because of the histologic similarity of the propulsive vein and tarsus-conjunctival layer. The thinness, texture and anatomical structure of propulsive veins make them well-suited for this task. They include all leg veins and cephalic and basilic veins in the arms. The authors typically harvest a vein from the distal third of the forearm but use the distal part of the leg for patients with poor-quality forearm veins.

Venous grafts were harvested from the forearm of six patients and the leg of one patient. Patients were followed for an average of 4.6 years. The authors reported good to outstanding cosmetic and functional results and no complications in all patients. None experienced a cancer relapse.

Financial Disclosures
Dr. Goldberg has no financial interests to disclose.