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Skin Grafts
Skin Grafts
Full-thickness skin grafts are commonly used for anterior lamellar defects of the upper and lower lids and medial canthus when direct closures are not possible. Adequate sizing of grafts is imperative to avoid ectropion associated with wound contraction. In general, grafts should be 25% to 30% larger than the defect when placed inside the bony orbit.15 More precise sizing for defects below the lid margin can be determined by placing the lower lid on full stretch upward with forceps or a suture to expand the defect maximally. A sterile nonadherent gauze pad can be used as a blotter to create a template with the lid on full stretch.16,17 Ipsilateral and contralateral upper eyelid crease provides the ideal tissue match and is well vascularized for rapid inosculation. Other donor sites include pre- and postauricular skin, supraclavicular, and inner arm skin.
Grafts from these areas must be thinned significantly to improve tissue match and reduce bulkiness. Grafts can be fenestrated and tacked to the wound bed if needed. Dental wax or vaseline gauze bolsters can be used for gentle pressure postoperatively. Canthopexy sutures can be placed to support the lower lid and avoid ectropion associated with wound contraction. Modified Frost sutures can be placed to support the lid during the immediate postoperative period while tissue swelling may lead to tension on the lid margin.18 Split-thickness grafts are generally avoided in this area due to the possibility of excessive wound contraction.