Periocular reconstruction with acellular fish skin xenograft after severe thermal burn: A case report

After a thermal burn the eyelids are highly susceptible to cicatricial forces. Donor sites for full-thickness skin grafts are limited in patients with large total body surface area burns. Acellular fish-skin xenografts are non-mammalian dermal substitutes that support neovascularization and granulation in burns and periocular defects. We report a case of a 47-year-old man who presented with approximately 50% total body surface area burns. He developed progressive cicatricial ectropion of all four eyelids and subsequent exposure keratopathy. Given the extent of his burns and limited donor sites, he underwent reconstruction of all four eyelids using fish-skin xenografts. Three surgeries using fish-skin xenografts achieved decreased scarring and restored lid-globe apposition. Subsequent full-thickness skin grafting was then performed. At final follow-up, the patient had a stable ocular surface, no recurrent ectropion or entropion, and only mild residual lagophthalmos. Acellular fish-skin xenografts are highly valuable for complex thermal burns with high contracture risk.