McDonald Heather M, McDonald Katherine A, McDonald Hector
Department of Ophthalmology, Western University, London, ON, Canada.
Division of Dermatology, University of Toronto, Toronto, ON, Canada.
Front Surg. 2023 Feb 24;10:1038952. doi: 10.3389/fsurg.2023.1038952. eCollection 2023.
The free bilamellar autograft (FBA) procedure involves harvesting a free, full-thickness section of eyelid tissue from one of the patient's healthy eyelids to reconstruct a large defect of the involved eyelid. No vascular augmentation is employed. The purpose of this study was to determine the structural and cosmetic results of this procedure.
A case series was performed, looking at patients who underwent the FBA procedure for large, full-thickness eyelid defects (>50% eyelid length) between 2009 and 2020 at a single oculoplastic surgical centre. Basal cell carcinomas most frequently met criteria for the procedure. OHSN-REB waived ethics approval. All surgeries were performed by one surgeon. A single operation, with surgical steps reported in detail, was completed with follow-up documentation at ideally 1 day, 1 week, 1 month, 3 months, 6 months, and 1 year. The mean follow-up period was 28 months.
Thirty-one patients (17 males, 14 females, mean age 78-years-old) were included in the case series. Comorbidities included diabetes and smoking. Most patients had known basal cell carcinomas removed from the upper or lower eyelid. The mean widths of the recipient and donor sites were 18.8 and 11.5 mm, respectively. All 31 FBA surgeries resulted in structurally functional, cosmetically pleasing, and viable eyelids. Six patients developed minor graft dehiscence, 3 developed an ectropion, and 1 developed mild superficial graft necrosis secondary to frostbite, which fully recovered. Three healing phases were identified.
This case series adds to the currently sparse data on the free bilamellar autograft procedure. The surgical technique is clearly articulated and illustrated. The FBA procedure is a simple and efficient alternative to current surgical techniques in the reconstruction of full-thickness upper and lower eyelid defects. The FBA provides functional and cosmetic success, despite the absence of an intact blood supply, with decreased operative time and faster recovery.
游离双板层自体移植（FBA）手术是从患者一侧健康眼睑获取一块游离的全层眼睑组织，用于修复患侧眼睑的大面积缺损。该手术未采用血管增强技术。本研究的目的是确定该手术的结构和美容效果。
进行了一项病例系列研究，观察2009年至2020年期间在单个眼部整形手术中心接受FBA手术治疗大面积全层眼睑缺损（>眼睑长度的50%）的患者。基底细胞癌最常符合该手术标准。OHSN-REB豁免了伦理批准。所有手术均由一名外科医生完成。完成了一次手术，并详细报告了手术步骤，理想情况下在术后1天、1周、1个月、3个月、6个月和1年进行随访记录。平均随访期为28个月。
该病例系列纳入了31例患者（17例男性，14例女性，平均年龄78岁）。合并症包括糖尿病和吸烟。大多数患者的上睑或下睑有已知的基底细胞癌被切除。受区和供区的平均宽度分别为18.8和11.5毫米。所有31例FBA手术均获得了结构功能良好、美容效果满意且存活的眼睑。6例患者出现轻微移植裂开，3例出现睑外翻，1例因冻伤继发轻度浅表移植坏死，但完全恢复。确定了三个愈合阶段。
该病例系列增加了目前关于游离双板层自体移植手术的稀少数据。清晰阐述并说明了手术技术。FBA手术是目前全层上睑和下睑缺损重建手术技术的一种简单有效的替代方法。尽管没有完整的血供，但FBA手术仍取得了功能和美容上的成功，且手术时间缩短，恢复更快。
