How and when of eyelid reconstruction using autologous transplantation

Table 1 Studies in literature regarding reconstructive eyelid surgery

What	Where	Type of tissue transplant	Ref.	Conclusions
Grafts	Bilamellar reconstruction	Skin graft + tarsoconjunctival graft with orbicularis oculi muscle advancement	Doxanas[11], 1986; Kakizaki et al[10], 2009	Orbital part muscle mobilization allows full thickness eyelid reconstruction using two grafts due to its vascular support
		Skin graft + tarsal graft	Bortz et al[12], 2020	Reconstruction of lower eyelid defects with a free tarsal graft and overlying free skin graft resulted in an acceptable functional and aesthetic lower eyelid suggesting that retention of or provision of vascular support in either the anterior or posterior lamella may not be necessary
	Anterior lamella	Skin graft	Alghoul et al[9], 2013	Anterior lamellar defects can be reconstructed with a full-thickness skin graft. Split-thickness skin grafts should not be used
		Skin graft	Shorr et al[14], 2003	Upper eyelid skin grafting can be performed with good cosmetic results to address corneal decompensation in patients who have acquired lagophthalmos from anterior lamellar insufficiency
	Posterior lamella	Tarsoconjunctival graft	Hawes et al[17], 2011	Essential component of eyelid reconstruction as it provides an anatomically similar tissue for the inner layer of reconstructed eyelids. Patients receiving a free tarsoconjunctival graft were less likely to require surgery to repair eyelid margin erythema than those receiving a Hughes tarsoconjunctival flap
			Yazici et al[23], 2020	Lateral periorbital bilobed flap with tarsoconjunctival graft can be a good alternative for the single-stage reconstruction of large upper eyelid defects
			Bengoa-González et al[24], 2019	Reconstruction of upper eyelid defects secondary to malignant tumors with a newly modified Cutler-Beard technique with tarsoconjunctival graft gives stability to the new upper eyelid, avoiding retraction caused by scarring
		Hard-palate mucoperiosteal	Yue et al[26], 2020; Ito et al[27], 2007	HPM may be considered the optimal choice for reconstructing the posterior lamella of the eyelids because it has similar histological composition and texture to the tarsoconjunctiva
			Hendriks et al[28], 2020	The use in upper eyelid reconstruction is controversial because hard-palate mucosa is composed of keratinized, stratified squamous epithelium, which can irritate the cornea. Despite this, excellent results were reported for its use in upper eyelid posterior lamellar reconstruction
		Chondromucosal graft	Yamamoto et al[33], 2017	Ear cartilage is useful because it is easy to harvest and fabricate, has suitable flexibility, and provides adequate support. Chondromucosal grafts from the nasal septum consist of highly supportable tissue. It lacks softness and flexibility, and harvesting is limited
			Suga et al[34], 2016	Ear cartilage fits well to bulbar surface. It has lower complication rate, while in the nose septal perforation and more bleeding can occur
			Hendriks et al[28], 2020	The use of alar or triangular cartilage provides a thinner but smaller sized sample, with good adaptability in eyelid reconstruction but raised the problem of donor site morbidity
		Scapha chondrocutaneous graft	Uemura et al[36], 2016	The scapha cartilage graft with small skin, round and soft with a shape similar to that of the lower lid, affords a good fit to the eye globe
		Dermis fat graft	Kuzmanović Elabjer et al[39], 2018	Provides stiffness, additional surface area, and a scaffold. Helps with vascularization and decreases fat tissue atrophy. It can be flat or domed
		Venous graft	Barbera et al[40], 2008	VGs obtained by propulsive venous vessels are the most suitable for this reconstruction because of their thinness, texture, and anatomical structure
			Tomassini et al[41], 2012	By properties of elasticity, smoothness, and concavity, the VG conforms to the globe without inducing a chronic inflammatory reaction on the bulbar conjunctiva or on the cornea
			Scevola et al[42], 2015	Safe, fast, and easily reproducible compared with chondroseptal graft
		Galea or pericranium graft	Ibáñez-Flores et al[43], 2019	Pericranial graft provides enough tissue to cover large defects, with an appropriate volume and a non-painful postoperative period
		Buccal mucosa graft	Grixti and Malhotra[44], 2018; Jin and Cao[45], 2021	It lacks structural integrity. It is too weak and small to support the lower eyelid, shrinking substantially during the postoperative period, so it should be used in combination with cartilage
Flaps	Bilamellar reconstruction	Neurovascular free flap from the first web space of the foot	Chait et al[46], 1980
		Free flap based on the second metacarpal artery	Yap et al[47], 1997
		Free dorsalis pedis flap	Thai et al[48], 1999	Free flap used for outer lamella and conjunctival flap for inner lamella
		Free forearm flap	Kushima et al[49], 2003	Entire upper eyelid reconstruction and a hard palate graft for the posterior one
			Ghadiali et al[50], 2016	Upper and lower eyelid total reconstruction where an extensive tissue loss of the ipsilateral forehead and temple. Tarsal plate of the eyelids was rebuilt by palmaris tenon grafts
			Iwanaga et al[51], 2019	2 cases of functional upper eyelid defect reconstruction. They used a free flap elevated with palmaris longus tenon split into two strips: One fixed to the frontalis muscle to achieve the opening function and the second to the medial palpebral ligament and the lateral orbicularis muscle to achieve the closing function
		ALT flap	Rubino et al[52], 2008	Upper and lower eyelid unilateral full thickness reconstruction with ALT free flap in a patient with no available adjacent tissues, involved in extended burns, and no possibility of using RFF

ALT: Anterolateral; HPM: Hard-palate mucoperiosteal; RFF: Radial forearm flap; VGs: Venous grafts.