Periocular Reconstruction Utilizing the Integra Dermal Regeneration Template

Area of Science:

• Ophthalmology
• Dermatology
• Plastic Surgery

Background:

• Periocular skin cancer excision often results in complex defects requiring specialized reconstruction.
• The Integra dermal regeneration template (DRT) is a bioengineered skin substitute used in various reconstructive scenarios.

Purpose of the Study:

• To evaluate the efficacy and outcomes of using DRT for periocular reconstruction following Mohs or surgical excision of cutaneous malignancies.
• To assess the incidence of postoperative cicatricial eyelid malposition after DRT application in the periocular region.

Main Methods:

• A retrospective study was conducted on adult patients undergoing periocular reconstruction with DRT between 2017 and 2023.
• Defects involved at least one periocular subunit, with primary outcome being cicatricial eyelid malposition.
• Data collected included defect size, location, reasons for DRT use, re-epithelialization time, and malposition incidence.

Main Results:

• Sixteen patients (mean age 70.6 years) with large periocular defects (mean 27.0 cm²) were included.
• Eighty-one percent of defects involved more than one periocular subunit.
• Fifty-six percent of patients developed cicatricial eyelid malposition, most commonly affecting the brow and nasal sidewall.

Conclusions:

• DRT is a viable option for reconstructing extensive periocular defects after cutaneous malignancy excision, especially when margins are unclear or for specific patient factors.
• The significant incidence of eyelid malposition necessitates thorough preoperative counseling for patients considering DRT reconstruction.
• Further research may explore techniques to mitigate malposition risks associated with DRT in periocular reconstruction.