Composite grafts in eyelid reconstruction: the complications and outcomes

To describe the outcomes and complications for composite eyelid grafts in a large case series over a 9-year period.

A retrospective study of all patients who underwent a composite graft for eyelid reconstruction between January 2000 and May 2009. A composite eyelid graft involves the excision of a full thickness pentagonal wedge from the donor eyelid, which is inserted into the recipient eyelid defect. The orbicularis muscle is discarded from the composite graft. Initial diagnosis, complications, postoperative eyelid contour and colour were recorded.

Forty-two patients were identified in the study period; the mean age was 69 years. Reconstruction following basal cell carcinoma excision was the commonest indication for surgery. Thirty-five composite grafts were performed for lower eyelid defects and seven for upper lid defects. The average size of the grafts was 9.1 (range 7-12) mm. Five patients required two grafts to reconstruct the defect. Thirty-six (86%) patients achieved a satisfactory contour and 33 (78%) patients had good matching skin colour. Partial dehiscence occurred in five patients and three patients had bulkiness of the graft postoperatively. We had no episodes of graft failure, although two patients had skin necrosis, which resolved.

Composite eyelid grafts when combined with mobilisation of the recipient orbicularis muscle can result in good preservation of eyelid function with satisfactory cosmesis.