One-Stage Reconstruction of a Full-Thickness Lower Eyelid Defect Using Preputial Inner Mucosa Graft

Full-thickness eyelid defects present a significant reconstructive challenge, as successful repair must restore both ocular protection and periocular aesthetics. Reconstruction of the posterior lamella is particularly critical, since inadequate support can lead to corneal exposure, entropion, or eyelid retraction. Conventional substitutes for conjunctival lining are often limited by donor-site morbidity, insufficient tissue availability, or the risk of eyelid-globe adhesions. The authors describe a single-stage technique using autologous preputial mucosa as a posterior lamellar substitute in lower eyelid reconstruction. A 55-year-old male with a traumatic full-thickness defect underwent circumcision, and the inner preputial mucosa was harvested and grafted to the conjunctival margin. The anterior lamella was reconstructed with local nasolabial and advancement flaps. At 1-year follow-up, the graft remained viable, maintaining stable eyelid contour, adequate lubrication, and satisfactory functional and aesthetic outcomes without adhesions or ocular surface complications. This case demonstrates that preputial mucosa is a thin, pliable, and readily available autologous graft for posterior lamellar reconstruction, avoiding additional donor-site morbidity. This novel technique may provide a valuable option for plastic surgeons and warrants further evaluation in larger clinical series.