Repair of a Full-thickness Eyelid Defect With a Bilamellar Full-thickness Autograft in a Porcine Model (Sus scrofa)

It has been demonstrated the pedicle of a tarsoconjunctival flap advancement does not appear to supply the flap itself and the vascularization of the remaining eyelid/tear film is thought to offer adequate nourishment for survival of the flap; as such, a swine model was constructed to assess the viability of a bilamellar autograft for repair of large full-thickness eyelid defects.

Full-thickness defects of varying sizes were created in each lower eyelid of 4 Yorkshire/Yorkshire crossed swine. The defects were then closed with a full-thickness ipsilateral graft from the upper eyelid. Large full-thickness defects were then created in the upper and lower eyelids of 8 Yorkshire/Yorkshire crossed swine and closed with bilamellar autografts from the contralateral eyelids. The subjects were then monitored postoperatively and assessed clinically for graft viability at postoperative days 1, 7, and 30. At the conclusion of the 30-day postoperative monitoring period, necropsy was performed and histopathologic analysis utilized to assess cell morphology and vessel ingrowth of the graft sites.

In total, 28 full-thickness bilamellar grafts were constructed and examined. At the conclusion of the postoperative monitoring period, 27 of the grafts were deemed clinically viable and vascular ingrowth was determined to be equivalent to unaffected eyelid sections by histopathologic analysis. One case of postoperative hematoma was noted in the failed graft. One case of postoperative wound dehiscence required subsequent surgical repair. No clinically significant notching of the graft sites was noted. No cases of wound infection, corneal decompensation, or forniceal shortening were identified.

This analysis demonstrates the viability of a full-thickness bilamellar autograft as a surgical alternative in the repair of large full-thickness eyelid defects in a porcine model. The postoperative outcomes are consistent with the recent literature. Additional studies need to be performed to assess the procedure's clinical utility in human subjects before incorporation into clinical practice.