Viability of full-thickness skin grafts used for correction of cicatricial ectropion of lower eyelid in previously irradiated field in the periocular region.

BACKGROUND The purpose of this study was to evaluate the viability of skin grafts used for correction of cicatricial ectropion resulting from previous ablative surgery and radiotherapy for head and neck cancer and to report overall outcomes of cicatricial ectropion repair. METHODS This is a retrospective, noncomparative case series of all consecutive patients with head and neck cancer who had been exposed to high-dose radiation therapy in their periocular region and had surgical correction of their lower eyelid cicatricial ectropion through placement of a full-thickness skin graft and a lower eyelid tightening procedure by the same surgeon. The primary outcome measure was skin graft viability. Secondary outcome measures comprised postoperative complications, the overall outcome of ectropion repair as judged by improvement in symptoms of exposure keratopathy, and dependence on lubricating eye drops and ointments, as well as cosmetic improvement measured through a grading scale based on the degree of inferior scleral show and/or tarsal conjunctival eversion. RESULTS Twenty-five patients were eligible for the study. Nineteen men and 6 women had a median age of 63 years (range, 20-84 years). All 25 patients had high-dose radiation therapy for their head and neck cancer. All but 1 patient had major cancer ablative surgery performed before radiation therapy. Thirteen of 25 patients also received chemotherapy. There was 100% viability of the skin grafts used for the repair of lower eyelid cicatricial ectropion. There were a few postoperative complications including the need for revision surgery to correct residual ectropion in the lower eyelid in 2 patients, and a third patient required a revision surgery due to upper eyelid retraction and lagophthalmos after harvest of skin graft from the upper eyelid. Improvement was noted in the subjective symptoms in 22 of 25 patients (88%), whereas 17 patients (68%) were noted to have improvement in their clinical findings on slit lamp examination. All 20 patients, for whom good quality photos were available, had improvement in the degree of cicatricial lower eyelid ectropion as measured by the amount of inferior scleral show and tarsal conjunctival eversion, although 11 patients had some residual ectropion. All 20 had either good or excellent results in the appearance of their skin grafts. CONCLUSION Our findings suggest that full-thickness skin grafts are a nice option for correction of cicatricial lower eyelid ectropion in a previously radiated field; 100% of the grafts survived. The majority of patients had improvement of ocular surface damage and symptoms, with a decreased dependence on topical lubricants. All evaluable patients had improvement in the degree of cicatricial lower eyelid ectropion, although close to one-half of patients had some mild residual ectropion. The majority of patients had excellent appearance of the skin graft.