Bolster for the tarsoconjunctival flap-skin graft

When skin grafts are used in the reconstruction of eyelid defects, they are usually covered by a Telfa bolster sutured to surrounding tissue. The bolster creates a contact between the underlying skin graft and the remaining eyelid, which promotes vascularization of the skin graft, increasing its chance of viability. However, when a skin graft is applied over a tarsoconjunctival flap, a bolster is not typically used. This article describes the use of a bolster over a skin graft that is applied to the tarsoconjunctival flap to increase the chance of skin graft survival. The author reports having used this technique in hundreds of cases without the loss of any skin graft.