Abstract
The use of split-thickness dermal grafts for successful repair of corneal and scleral defects is reported in 10 patients (11 eyes) who had non-infectious, impending, or overt ocular perforation. In all patients, traditional methods of reconstruction were deemed inappropriate or had already failed. Corneo-scleral defects occurred after various operations: pterygium excision, retinal detachment repair, insertion of a keratoprosthesis (Cardona implant) into an opaque, vascularised cornea, and penetrating keratoplasty. Other causes of corneoscleral defects were scleromalacia perforans, idiopathic systemic vasculitis, alkali burn, ocular cicatricial pemphigoid, and band keratopathy with recurrent erosion following intraocular metallic foreign body. We propose the use of split-thickness grafts: (1) when adjacent conjunctiva is inadequate to cover a corneoscleral defect owing to its large size or great depth or to conjunctival scarring from previous operations, injury, or ocular cicatricial pemphigoid; or (2) as an alternative to autogenous grafts such as conjunctiva, cartilage, fascia lata, tibial periosteum, or mucous membrane as well as to homologous scleral and lamellar grafts. Dermal grafts are advantageous in that they are autogenous, non-antigenic, survive on avascular surfaces, and self-epithelialise and, thus, need not be covered by conjunctiva. Furthermore, they are pliable, have excellent tensile strength, provide ample tectile support, and are abundantly available. Dermal grafts are harvested from the dermal bed of the thigh after an epidermal flap is hinged at one end.
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- Khan J. A. Dermal graft. Alternative to Gunderson flap allows fitting scleral shell over sensitive cornea. Ophthal Plast Reconstr Surg. 1990;6(4):260–264. doi: 10.1097/00002341-199012000-00006. [DOI] [PubMed] [Google Scholar]
- MERZ E. H. SCLERAL REINFORCEMENT WITH AORTIC TISSUE. Am J Ophthalmol. 1964 May;57:766–770. doi: 10.1016/0002-9394(64)92224-x. [DOI] [PubMed] [Google Scholar]
- Mauriello J. A., Jr, Fiore P. M., Pokorny K. S., Cinotti D. J. Use of split-thickness dermal graft in the surgical treatment of corneal and scleral defects. Am J Ophthalmol. 1988 Mar 15;105(3):244–247. doi: 10.1016/0002-9394(88)90003-7. [DOI] [PubMed] [Google Scholar]
- Mauriello J. A., Jr, Han K. H., Wolfe R. Use of autogenous split-thickness dermal graft for reconstruction of the lining of the exenterated orbit. Am J Ophthalmol. 1985 Sep 15;100(3):465–467. doi: 10.1016/0002-9394(85)90515-x. [DOI] [PubMed] [Google Scholar]
- Putterman A. M. Conjunctival flap-cosmetic shell-ptosis procedure. Treatment of blepharoptosis in severe keratopathy. Arch Ophthalmol. 1989 Dec;107(12):1816–1818. doi: 10.1001/archopht.1989.01070020898035. [DOI] [PubMed] [Google Scholar]
- RENARD G., LELIEVRE, MAZEL Scléromalacie perforante. Bull Mem Soc Fr Ophtalmol. 1953;66:243-9; discussion, 249-51. [PubMed] [Google Scholar]
- Reed G. F., Zafra E., Ghyselen A. L., Goldstein J. C., Robinett W. V. Self-epithelization of dermal grafts. Arch Otolaryngol. 1968 May;87(5):518–521. doi: 10.1001/archotol.1968.00760060520015. [DOI] [PubMed] [Google Scholar]
- Spoor T. C., Ramocki J. M., Cowden J. W. A periosteal-temporalis fascia pedicle flap for repairing impending ocular perforations and extruding keratoprostheses. Am J Ophthalmol. 1989 Dec 15;108(6):704–708. doi: 10.1016/0002-9394(89)90865-9. [DOI] [PubMed] [Google Scholar]
- THOMPSON N. The subcutaneous dermis graft. A clinical and histologic study in man. Plast Reconstr Surg Transplant Bull. 1960 Jul;26:1–22. doi: 10.1097/00006534-196007000-00001. [DOI] [PubMed] [Google Scholar]
- Torchia R. T., Dunn R. E., Pease P. J. Fascia lata grafting in scleromalacia perforans with lamellar corneal-scleral dissection. Am J Ophthalmol. 1968 Oct;66(4):705–709. doi: 10.1016/0002-9394(68)91293-2. [DOI] [PubMed] [Google Scholar]