Periocular Reconstruction Utilizing the Integra Dermal Regeneration Template

To describe the use of the Integra dermal regeneration template (DRT) for periocular reconstruction following Mohs micrographic or surgical excision of cutaneous malignancy.

This is a retrospective study of adult patients who underwent periocular reconstruction using DRT from 2017 to 2023 at a single academic institution. All patients had a postexcision defect involving at least 1 periocular subunit, including brow, temple, cheek, nasal sidewall, medial and/or lateral canthal areas. The primary outcome measure was the incidence of postoperative cicatricial eyelid malposition.

Sixteen patients were included (62.5% male, 70.6 ± 11.3 years old [mean ± SD]). Mean postexcision defect measured 27.0 ± 21.4 cm 2 , with 13 patients (81.3%) having a defect that involved more than 1 periocular subunit, with medial canthal area and nasal side wall being most common (37.5%). DRT was chosen for staged reconstruction for 4 cases where the final stage of excision reached periosteum/bone, 3 cases awaiting clearance of margins, 2 cases of perineural invasion, and 3 cases medically unfit to undergo general anesthesia, when specified. Re-epithelialization occurred 34 ± 8 days following DRT placement with either full thickness or split thickness skin graft, or adjacent tissue transfer. Nine patients (56.3%) developed cicatricial eyelid malposition, with the brow and nasal side wall having the greatest incidence. Means of re-epithelialization was not significantly associated with the incidence of malposition ( p = 0.87).

This series demonstrates DRT's utility in the reconstruction of large periocular defects following excision of cutaneous malignancy, particularly cases that lack pathological clearance at the time of reconstruction. The incidence of subsequent eyelid malposition is not insignificant and merits preoperative discussion.