Skin graft with dermis and appendages generated in vivo by cell competition.

Autologous skin grafting is a standard treatment for skin defects such as burns. No artificial skin substitutes are functionally equivalent to autologous skin grafts. The cultured epidermis lacks the dermis and does not engraft deep wounds. Although reconstituted skin, which consists of cultured epidermal cells on a synthetic dermal substitute, can engraft deep wounds, it requires the wound bed to be well-vascularized and lacks skin appendages. In this study, we successfully generate complete skin grafts with pluripotent stem cell-derived epidermis with appendages on p63 knockout embryos' dermis. Donor pluripotent stem cell-derived keratinocytes encroach the embryos' dermis by eliminating p63 knockout keratinocytes based on cell-extracellular matrix adhesion mediated cell competition. Although the chimeric skin contains allogenic dermis, it is engraftable as long as autologous grafts. Furthermore, we could generate semi-humanized skin segments by human keratinocytes injection into the amnionic cavity of p63 knockout mice embryos. Niche encroachment opens the possibility of human skin graft production in livestock animals.

A Novel Treatment for Giant Congenital Melanocytic Nevi Combining Inactivated Autologous Nevus Tissue by High Hydrostatic Pressure and a Cultured Epidermal Autograft: First-in-Human, Open, Prospective Clinical Trial.

BACKGROUND: Giant congenital melanocytic nevi are large skin lesions associated with a risk of malignant transformation. The authors developed a novel treatment to reconstruct full-thickness skin defects by combining an inactivated nevus as the autologous dermis and a cultured epidermal autograft. The first-in-human trial of this treatment was performed. METHODS: Patients with melanocytic nevi that were not expected to be closed by primary closure were recruited. The full-thickness nevus of the target was removed and inactivated by high hydrostatic pressurization at 200 MPa for 10 minutes. The inactivated nevus was sutured to the original site, and a cultured epidermal autograft was grafted onto it 4 weeks later. Patients were followed for up to 52 weeks. RESULTS: Ten patients underwent reimplantation of the pressurized nevus, and one patient dropped out. The recurrence of nevus at 52 weeks was not detected by pathological diagnosis in any patients. The L* value at 52 weeks was significantly higher than that of the target nevus. One patient received skin grafting due to contracture of the reconstructed skin. The epithelized area of the reconstructed skin, as the percentage of the original target nevus, was 55.5 ± 19.4 percent at 12 weeks and 85.0 ± 32.4 percent at 52 weeks. CONCLUSIONS: The inactivated nevus caused inflammation and contracture for several months. However, no recurrence was observed, and combination therapy using an inactivated nevus with a cultured epidermal autograft may therefore be a novel treatment of giant congenital melanocytic nevi. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

The efficacy of artificial dermis combined with continuous vacuum sealing drainage in deep neck multiple spaces infection treatment.

ABSTRACT: Deep neck abscesses are dangerous. Artificial dermis combined with seal negative pressure drainage is a new technique for treating refractory wounds.To compare the efficacy of vacuum sealing drainage (VSD) with that of traditional incision drainage approaches for treating deep neck multiple spaces infections.This retrospective analysis includes patient data from our hospital collected from January 2010 to March 2020. A total of 20 cases were identified. Based on the treatment methods, the patients were divided into the VSD group and the traditional group. Inflammation indicators (white blood count, WBC), duration of antibiotic use, hospitalization time, doctors' workload (frequency of dressing changes) and treatment cost were analyzed and compared between the two groups.Of the 20 patients, 11 patients underwent treatment with VSD, while the other 9 underwent traditional treatment. All patients were cured after treatment. Compared with the traditional group, the VSD group had a slower decline in the inflammation index, shorter duration of antibiotic use, shorter hospital stay, and lower doctor workloads (P < .001). There was no significant difference in treatment cost between the two groups (P > .05).VSD technology can markedly improve the therapeutic effect of deep neck multiple spaces infection. This treatment method can be used to rapidly control infections and is valuable in the clinic (P > .05).

Superior Capsular Reconstruction Using Dermal Allograft Is a Safe and Effective Treatment for Massive Irreparable Rotator Cuff Tears: 2-Year Clinical Outcomes.

PURPOSE: To evaluate functional, symptomatic, and diagnostic imaging outcomes after arthroscopic superior capsular reconstruction (SCR) using dermal allograft in patients with massive irreparable rotator cuff tears. METHODS: From 2015 to 2017, this multicenter study retrospectively evaluated patients undergoing arthroscopic SCR for treatment of symptomatic massive rotator cuff tears. Study criteria included the presence of a massive irreparable rotator cuff tear with retraction to the glenoid without diffuse bipolar cartilage loss, Grade 4 or 5 Hamada classification, and subscapularis pathology that could not be addressed. All SCR procedures were performed with neutral abduction of the arm at the time of implantation. Outcome measures included visual analog pain scale (VAS) score, the American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE) score, and active forward elevation (FE) through 2 years postoperatively. Imaging analyses included radiographs, ultrasound, and magnetic resonance imaging at 6 months and 1 year. RESULTS: Fourteen patients met all study criteria including required follow-up. There were statistically significant improvements in VAS pain (3.3-0.6, P = .001), ASES (55.0-86.5, P < .0001), SANE (33.1-71.5, P < .0001), and active FE (128-172, P = .0005) with mean follow-up of 2.1 years. Twelve patients (86%) met the minimum clinically important difference in VAS pain, ASES, and SANE. Thirteen grafts (93%) had ultrasonographic evidence for vascularity by 1 year postoperatively. There were 2 graft complications (14%) with one (7%) requiring revision to reverse total shoulder arthroplasty. CONCLUSIONS: Arthroscopic SCR using dermal allograft can be a safe and effective treatment option for patients with massive irreparable rotator cuff tears with statistically significant improvements in VAS pain, ASES, SANE, and active FE at 2-years postoperatively, with 93% of grafts demonstrating vascularity at 1-year postoperatively. Neutral abduction of the arm at the time of implantation resulted in positive clinical outcomes and may decrease graft failure rate. LEVEL OF EVIDENCE: Level IV, case series.

Superior Capsule Reconstruction Using Fascia Lata Allograft Compared With Double- and Single-Layer Dermal Allograft: A Biomechanical Study.

PURPOSE: To biomechanically characterize superior capsule reconstruction (SCR) using fascia lata allograft, double-layer dermal allograft, and single-layer dermal allograft for a clinically relevant massive irreparable rotator cuff tear involving the entire supraspinatus and 50% of the infraspinatus tendons. METHODS: Eight cadaveric specimens were tested in 0°, 30°, and 60° abduction for (1) intact, (2) massive rotator cuff tear, (3) SCR using fascia lata, (4) SCR using double-layer dermis, and (5) SCR using single-layer dermis. Superior translation and subacromial contact pressure were measured. Statistical analysis was conducted using repeated measures ANOVA or paired t test with P < .05. RESULTS: Massive rotator cuff tear significantly increased superior translation of the humeral head at all abduction angles (P < .05). At 0° abduction, all SCR conditions significantly decreased superior translation compared with the massive tear but did not restore translation (P < .05) to intact. Fascia lata and double-layer dermis SCR restored superior translation to intact at 30° and 60° of abduction, but single-layer dermis did not. Subacromial contact pressure at 0° of abduction significantly decreased with SCR with fascia lata and double-layer dermis compared with tear. At 30°, all SCR conditions significantly decreased subacromial contact pressure. Single-layer dermis graft thickness significantly decreased more than fascia lata during testing (P = .02). CONCLUSION: For SCR tensioned at 20° glenohumeral abduction, all 3 graft types may restore superior translation and subacromial contact pressure depending on the glenohumeral abduction angle; fascia lata and double-layer dermis may be more effective than single-layer dermis. CLINICAL RELEVANCE: If a dermal graft is to be used for SCR, consideration should be given to doubling the graft for increased thickness and better restorative biomechanical properties, which may improve clinical outcomes following SCR.

Treating Wounds With an Avascular Component With a Dermal Regenerative Template.

INTRODUCTION: Partially avascular wounds pose a challenge to wound care surgeons. OBJECTIVE: The authors reviewed the literature and institutional results on the use of a dermal regenerative template (DRT) over partially avascular wounds to quantify the ability of the DRT to vascularize over these wounds. MATERIALS AND METHODS: A review of the literature was performed using Ovid MEDLINE, Google Scholar, and Cochrane Library. Patient demographics, comorbidities, wound types, surface area of avascular tissues, and skin graft take were analyzed. A retrospective review of institutional cases was conducted. RESULTS: A total of 32 articles met inclusion criteria. The retrospective review included 26 patients with partially avascular wounds reconstructed with the DRT. Seventeen patients experienced 100% graft take, 6 experienced partial take, and 3 suffered complete loss. The percent and absolute size of avascular surface area in the wound was significantly lower in cases of complete graft take compared with partial take and complete loss (1.9% and 2.7 cm2; 9.3% and 10.0 cm2; 18.0% and 9.3 cm2, respectively, P ⟨ .001). Chronic wound status (P ⟨ .001) was significantly associated with less graft take. CONCLUSIONS: This literature review and retrospective study confirm the DRT is a viable option to provide vascularized coverage over wounds with avascular components. This study suggests the DRT is more reliable in wounds with less than 1.9% avascular tissues and less successful in chronic wounds.

Preliminary studies of hair follicle regeneration by injections of epidermal stem cells and dermal papilla cells into nude mice.

The ultimate goal of organ regenerative therapy is to reproduce fully functional organs to replace which have been damaged as a result of diseases or injury. Although several studies claimed that using different types of cells in some animal models promote hair follicles regeneration, more researches can be done to develop a sufficient and efficient protocol to induce hair generation from different animal models. In this study, we investigated the therapeutic potentials for hair follicle formation by injecting a mixture of epidermal stem cells and dermal papilla cells. Those cells were isolated and culture-expanded. Then we randomly allocated 8 nude mice into two groups. The experiment group received an injection of a mixture that containing of epidermal stem cells and dermal papilla cells. The control group received injection of keratinocyte serum-free medium. The hair follicles regeneration was observed and the injection area was harvested for HE staining. 14 day later, the regenerated hair shafts were observed and HE staining indicated that the newly hair follicle formed the correct structures in experiment group. Furthermore, the mixture injection induced a regular and multilayered stratified epidermis and the epidermis contained of hair follicle-likes structures. Our data showed that injection of a mixture of epidermal stem cells and dermal papilla cells could induce hair follicles regeneration and well-ordered epidermis formation. This study emphasized that the rearrangement of the interactions during seed cells and the niches of the seed cells is essential and necessary for tissue-engineered construct success.

B-Technique with dermis suspension: A new approach toward reduction mammaplasty combining short-scar with durability of results.

BACKGROUND: Dermis suspensions (DM) have been introduced in reduction mammaplasties (RM) to extend the durability of the results and improve the quality of the scar. The authors present a new method of RM that consists of completing the B-method of Regnault with a well-vascularized DM. OBJECTIVE: Analyze the efficacy of a reduction mammaplasty technique proposed by the authors. METHODS: The authors propose a comparison of two mamma reduction techniques based on a superior pedicle performed on 233 patients at the Medical University of Vienna, Department of Obstetrics and Gynecology, from 2010 to 2019. A total of 102 patients (Group A) were treated with a mammaplasty using Regnault's B-technique with a superior pedicle; 131 patients (Group B) were treated through a similar technique with additional support from an inferior-based deepithelialized pedicle for extra support. The assessment of patient satisfaction was performed by using the BREAST-Q for breast reduction; scar quality assessment was performed using a Patient and Observer Scar Assessment Scale (POSAS). RESULTS: Group A/Group B: 74/97 patients were operated bilaterally and 28/24 unilaterally. The amount of resected tissue ranged from 102-620 g to 30-810 g. Average BREAST-Q score for satisfaction with outcome was 82.3/86.1. POSAS was scored 35.2/37.6 to 23.2/24.4. Bottoming out after surgery was observed in 12 of 102 patients in Group A and 6 of 131 in Group B in the follow-up visits at 12, 18, and 36 months. CONCLUSION: The described technique proved to be fast, safe, and reliable, with a high level of patient satisfaction, less bottoming out, and better scar quality.

The Superior Capsular Reconstruction: Lessons Learned and Future Directions.

The ideal solution for the irreparable rotator cuff tear remains in question. A recent innovative technique, superior capsular reconstruction (SCR), has demonstrated promising results with some early clinical outcomes demonstrating statistically notable improvements in active forward flexion and American Shoulder and Elbow Surgeons scores. Multiple biomechanical studies have also demonstrated its ability to reduce superior translation of the humerus after massive rotator cuff tear. Even so, these results are still early and durability of the reconstruction over time needs to be determined. Although more than 15,000 SCRs have been done worldwide, there remains a paucity of outcome data and one must be vigilant to not allow enthusiasm to overtake critical evaluation. The potential mechanisms of action, including tenodesis effect, force coupler, or subacromial spacer, need further elucidation and the ideal indications for this procedure, as well as its technical optimization, and limitations have yet to be fully determined. The purpose of this review is to critically evaluate the biomechanical and clinical literature that has assessed SCR, along with the controversies and considerations encountered with this procedure.

Use of autologous dermal flap as mesh coverage in the treatment of large abdominal-wall defect in patients following massive weight loss: presentation of a novel surgical technique.

PURPOSE: Reconstruction of large abdominal-wall defects (AWD) in patients after massive weight loss (MWL) can be challenging. Patients are left with a sizeable amount of excess skin and subcutaneous tissue which can serve as a natural and readily available source of mesh coverage. In this article, we present our experience in the reconstruction of large AWD in patients after MWL, using autogenous dermal flaps combined with a synthetic mesh. METHOD: All patients with large AWD and MWL, diagnosed between January 2012 and December 2016, were considered to be candidates for the procedure. During the operation, an attempt was made to attain full closure of the defect above the mesh. In those patients for whom such closure was not possible, a dermal flap technique was used. Patients were closely monitored for at least 1 year. Outcome measures included early and late postoperative complications. Data are presented as mean ± standard deviation (SD). RESULTS: Over the study period, a total of 14 patients underwent a surgery involving combined mesh and dermal flap technique. Early post-operative complications included three patients who suffered from minor wound disruption and were treated with local dressings. One patient had an abdominal-wall hematoma that required an evacuation. Two patients suffered from an epidermal cyst and chronic sinuses that required surgical debridement. None of the patients experienced intra-abdominal complication, respiratory failure, or required ICU treatment. No mesh contamination or hernia recurrence was observed during the follow-up period of 22.25 ± 6.4 months. CONCLUSION: Autologous dermal flap combined with mesh technique may serve as an effective surgical alternative in patients after MWL with large AWD for whom full muscular coverage of the underlying prosthesis is not possible.

Filling Up the Valleys

Man has tried and sought to erase wrinkles and scars for millennia. Sadly, however, the most effective and permanent techniques have fallen into disuse and neglect due to lack of training in universities, lack of awareness on the part of both physicians and patients, and heavy mass marketing of injectable fillers. Dermal grafting is a standard, time honored method for permanent correction of deep facial defects. Our goal as dermatologists is to generate the best results for our patients, and also to develop our personal skills and talents to the utmost.

String Fat/Dermis Graft for Correction of Wrinkles and Scars.

Established creases and wrinkles do not predictably respond to the fat injection technique. The authors describe a minimally invasive yet simple technique to address recalcitrant facial rhytides and minor depressed scars. This technique optimally requires a concomitant procedure whereby suitable fat or dermis graft could be available for grafting without having to make another incision. However, if needed, the graft can be harvested from an easily concealed area such as postauricular sulcus. Preferably, dermis or a combination of fat and dermis is harvested in the form of strings using a pair of straight iris scissors. The sharp end of an 18-gauge needle is then used to create a tunnel in the subcutaneous plane beneath each line while releasing any fibrous bands. The string of dermis/fat is then engaged at the end of the 18-gauge needle and delivered into the subcutaneous tunnel with rotation and advancement of the needle. The authors have used this graft on 49 sites on 39 patients. The mean age of the patients was 57.6 years, with eight male and 31 female patients. The sites included rhytides in upper and lower lips, oral commissure, labial mental groove, and frown lines, and scars in the forehead, nasal dorsum, nasal tip, and eyebrows. String fat grafting is a simple and reliable method to address limited rhytides or depressed scars. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, V.

A Cultured Autologous Dermo-epidermal Skin Substitute for Full-Thickness Skin Defects: A Phase I, Open, Prospective Clinical Trial in Children.

BACKGROUND: The management of deep partial-thickness and full-thickness skin defects remains a significant challenge. Particularly with massive defects, the current standard treatment, split-thickness skin grafting, is fraught with donor-site limitations and unsatisfactory long-term outcomes. A novel, autologous, bioengineered skin substitute was developed to address this problem. METHODS: To determine whether this skin substitute could safely provide permanent defect coverage, a phase I clinical trial was performed at the University Children's Hospital Zurich. Ten pediatric patients with acute or elective deep partial- or full-thickness skin defects were included. Skin grafts of 49 cm were bioengineered using autologous keratinocytes and fibroblasts isolated from a patient's small skin biopsy specimen (4 cm), incorporated in a collagen hydrogel. RESULTS: Graft take, epithelialization, infection, adverse events, skin quality, and histology were analyzed. Median graft take at 21 days postoperatively was 78 percent (range, 0 to 100 percent). Healed skin substitutes were stable and skin quality was nearly normal. There were four cases of hematoma leading to partial graft loss. Histology at 3 months revealed a well-stratified epidermis and a dermal compartment comparable to native skin. Mean follow-up duration was 15 months. CONCLUSIONS: In the first clinical application of this novel skin substitute, safe coverage of skin defects was achieved. Safety and efficacy phase II trials comparing the novel skin substitute to split-thickness skin grafts are ongoing. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Microdermal Grafting for Color Regeneration of White Scars.

White scars are defined in this study as mature hypopigmented surgical or traumatic scars whose color is much lighter than surrounding skin, to the extent that they appear white. These scars are often obvious and very difficult to treat or mask. This 3-year retrospective study reports the outcomes from 38 recipients of a new microdermal grafting surgery we developed, which introduces melanocytes into the white scar lesion to regenerate skin color. The study shares 18 years of experience with this procedure, describes the surgical steps, offers videos of the procedures, and presents 4 cases. Between September 2013 and December 2016, 38 patients (30 females; 8 males) underwent microdermal grafting for color regeneration of white scars in our plastic surgery clinic. Most patients, 78.9%, received 1 treatment, 15.8% received 2 treatments, and 5.3% received 3 treatments. Three lay judges were asked to assess percentage pigmentation recovery by comparing photographic images of patients' preoperative and postoperative scars. Patients were also asked to assess, via a questionnaire, satisfaction and percentage improvement 1 year after surgical treatment. Lay judges found an average of 49% improvement after 1 session, 75% after 2 sessions, and 90% after 3 sessions. In total, 71.1% of the patients completed the questionnaire 1 year after the surgery. Average subjective improvement was 55% after 1 session, 88% after 2 sessions, and 95% after 3 sessions. The patient satisfaction rate was high. Microdermal grafting provides adequate treatment of white scars by regenerating melanocytes, although more than 1 session treatment may be needed.

Safety and efficacy of autologous noncultured dermal cell suspension transplantation in the treatment of localized facial volume loss: A pilot study.

BACKGROUND: Available options for correction of facial volume loss, such as synthetic fillers, autologous fat and cultured fibroblasts, have limitations viz. temporary effect and high cost. AIM: To assess the use of a novel technique, autologous non-cultured dermal cell suspension transplantation, for correction of localized facial volume loss due to inflammatory pathologies. METHODS: It was a pilot study conducted in the Dermatology Outpatient Department, All India Institute of Medical Sciences (AIIMS), New Delhi, India. Autologous non-cultured dermal cell suspension was transplanted in a total of 10 patients, out of which 5 had predominantly dermal loss and the rest had predominantly lipoatrophy. The donor tissue from the gluteal region was digested into a single cell suspension using collagenase-1 and injected into the recipient area. The outcome was assessed subjectively by patients and investigators and objectively using ultrasonography. Cell count, viability testing and measurement of mesenchymal stem cells were also done. RESULTS: On assessment of patients, the median improvement in the predominantly dermal atrophy group at 3 and 6 months was 70% (range: 10-90%) and 80% (range: 0-90%), respectively, and in the predominantly lipoatrophy group, 0% (range: 0-40) and 0% (range: 0-50), respectively. Mean thickness of dermis + subcutis at the baseline was 1.835 mm (range: 0.89-6.04 mm), which increased to 2.912 mm (range: 0.88-7.07 mm, P = 0.03) at 6 months. LIMITATIONS: Our pilot study has some limitations such as small sample size and heterogeneity of the recruited patients. CONCLUSIONS: Autologous non-cultured dermal cell suspension transplantation appears to be safe and effective in localized facial dermal defects because of inflammatory pathologies, but not effective in deeper defects.

Induction of angiogenic and inflammation-associated dermal biomarkers following acute UVB exposure on bio-engineered pigmented dermo-epidermal skin substitutes in vivo.

PURPOSE: Ultraviolet (UV) radiation adversely affects skin health at cellular and molecular levels. Hence, UV radiation can directly induce inflammatory responses in the dermis by inducing erythema, edema, inflammation, dermal fibroblasts alterations, and extracellular matrix modifications. METHODS: Human keratinocytes, melanocytes, and fibroblasts were isolated from skin biopsies, cultured, and expanded in vitro. Fibroblasts were seeded into collagen type I hydrogels that were subsequently covered by keratinocytes and melanocytes. These pigmented dermo-epidermal skin substitutes (pigmDESS) were transplanted for 5 weeks onto full-thickness skin wounds on the back of immuno-incompetent rats, exposed to a single UVB dose of 250 mJ/cm2 or unexposed and excised after 1 week. The effects onto the dermis were assessed regarding cell number, cell phenotype, and cell proliferation. Local inflammation by granulocytes (HIS48) or macrophages (CD11b, iNOS) was analyzed by immunohistochemistry staining. RESULTS: We observed a significantly enhanced ingrowth rate of blood capillaries, but not of lymphatic capillaries at 1 week post-irradiation. Moreover, the enhanced vascularization of pigmDESS after UVB exposure was concomitant with a high infiltration of granulocytes and monocytes/macrophages to the dermal part of grafts. In addition, a heterogeneous expression of HIF-1α and TNFα was detected at this early phase after UVB exposure. In local cellular response examination, results only show a moderate cell proliferation in the dermis. CONCLUSIONS: We were able to define early markers of UVB-induced effects in the dermis of pigmDESS. Overall, a single UVB dose induces temporary acute angiogenic and immune responses during the early post-irradiation phase in vivo.

Impact of human mesenchymal cells of different body site origins on the maturation of dermo-epidermal skin substitutes.

AIM OF THE STUDY: The use of autologous bio-engineered dermo-epidermal skin substitutes (DESS) yields a pivotal opportunity to cover large skin defects in human patients. These skin grafts consist of both epidermal and dermal compartments necessary for robust and permanent functional wound closure. In this study, we investigated the impact of mesenchymal cells derived from different body site origins on the expression pattern of diverse markers within DESS. METHODS: Human keratinocytes were obtained from interfollicular epidermis, and mesenchymal cells were isolated from foreskin, palmar skin, fat tissue, and tonsils. After expansion, epidermal cells were seeded on collagen I hydrogels containing stromal cells. These human DESS were transplanted on the back of immune-incompetent rats. After 3 weeks, transplants were excised and analyzed using immunohistology techniques. MAIN RESULTS: The macroscopic appearance of skin grafts containing tonsil, fat tissue, or palmar derived mesenchymal cells, was similar to substitutes with foreskin derived dermal fibroblasts. All skin grafts had a strong membrane-localized expression of Lingo-1 in the epidermis. Additionally, we observed an intense expression of transglutaminase 5 in upper epidermal cell layers of the skin grafts confirming a proper keratinocyte differentiation. Tropoelastin was localized throughout the dermal compartments and tightly in contact with the dermo-epidermal junction suggesting an advanced maturation of all skin grafts. CONCLUSIONS: Our data implicate that stromal cells derived from tonsil, fat tissue, and palmar skin can assume fibroblast functions supporting keratinocyte proliferation and differentiation. These findings indicate that distinct types of mesenchymal cells can be clinically used for skin engineering purposes.

[Use of the autologous dorsal dermis in reconstruction of the posterior palpebral lamella in blepharopoiesis]. / Utilisation du derme dorsal autologue en reconstruction lamellaire palpébrale postérieure en blépharopoïèse.

OBJECTIVES: Blepharopoiesis represents a double aesthetic and functional challenge. If anterior lamellar reconstruction is less discussed, the variety of posterior lamellar substitutes testifies that none is ideal. We report here our experience of the use of autologous dermal dermis as posterior lamellar substitutes in bilamellar blepharopoiesis. PATIENTS AND METHOD: We performed a single-center retrospective observational study of seven patients undergoing blepharopoiesis using dorsal dermal autograft as posterior lamellar substitute. RESULTS: Between September 2011 and January 2017, seven patients aged of 80.9 years on average were cared for. The defect, affecting in 6 cases on 7 the lower eyelid, concerned almost three-quarter of the length of the eyelid. These defects followed the excision of basal cell carcinomas. Procedures performed under local anesthesia have simple follow-up without complications of the donor site. The superficial surface of the graft in contact with eyeball was covered in 2.4 months with a non-keratinized squamous epithelium like the conjunctiva. Two patients presented ocular functional signs during 2 months without keratitis. Two patients required a second correction procedure. CONCLUSION: The use of the dorsal dermis seems reliable, simple, fast, possible under local anesthesia and sedation, achievable in one operative time, outpatient, without temporary tarsorraphy. The graft is available in large quantities and its removal is not morbid. The good functional and esthetic results suggest that the autologous dermal dermis could represent the main alternative to palatal fibromucosa as a posterior lamellar substitute in old population.

Dermis-fat graft for anophthalmic socket reconstruction: indications and outcomes / Enxerto dermo-adiposo para reconstrução da cavidade anoftálmica: indicações e resultados

ABSTRACT Purpose: To evaluate the outcomes of dermis-fat graft procedure for orbital volume replacement in anophthalmic socket. Methods: A retrospective chart review was performed studying all dermis-fat graft surgeries done at King Khlaed Eye Specialist Hospital in the last 10-year period. Sixty-two anophthalmic socket carriers underwent dermis-fat graft during the study period. Data were collected on characteristics of the patients, postoperative complications, cosmesis, and functional results such as the ability to hold an external prosthesis. Results: Mean age of the patients included in the study was 34.2 ± 9.7 years. There were 38.7% of patients with grade 3 anophthalmic socket, 64.5% of patients had an acquired anophthalmic socket, and dermis-fat graft was performed as a secondary procedure in 61.3% of patients. Postoperative complications included lagophthalmos (22.6%), graft necrosis (17.7%), pyogenic granuloma (12.9%), decreased graft size (12.9%), malpositioned lids (3.2%), and volume deficiency (3.2%). The prosthesis was held in place in 49 patients (79%) preoperatively and in 55 patients (88.7%) postoperatively. Conclusion: Dermis-fat graft is an excellent option for congenital or acquired as well as primary or secondary anophthalmic sockets, with or without contraction. The outcomes are favorable, and complications are rare.

RESUMO Objetivo: Avaliar os resultados obtidos com o uso do enxerto dermo-adiposo para reposição de volume em cavidade anoftálmica. Métodos: Estudo retrospectivo baseado em revisão de prontuários incluindo todas as cirurgias de enxerto dermo-adiposo realizadas nos últimos 10 anos no King Khaled Eye Specialist Hospital, Saudi Arabia. O enxerto dermo-adiposo foi realizado em 62 pacientes no periodo do estudo. Os dados analisados incluíram características dos pacientes, as complicações pós- operatórias e os resultados cosméticos e funcionais, tais como a habilidade de usar prótese externa. Resultados: A média de idade dos participantes foi de 34,2 ± 9,7 anos. Segundo a classificação das cavidades, 38,7% possuíam cavidade grau 3; 64,5% possuíam cavidade anoftálmica adquirida e o enxerto dermo-adiposo foi realizado como procedimento secundário em 61,3% dos pacientes. Após o procedimento 22,6% dos pacientes permaneceram com lagoftalmo, 17,7% tiveram necrose do enxerto, 12,9% desenvolveram granuloma piogênico, 12,9% tiveram redução do tamanho do enxerto, 3,2% permaneceram com as alterações no posicionamento palpebral e 3,2% continuaram com déficit de volume na órbita. Quarenta e nove pacientes (79%) eram capazes de usar prótese externa antes da cirurgia e depois do enxerto dermo-adiposo 55 (88,7%) puderam utilizar prótese externa. Conclusão: O enxerto dermo-adiposo é uma ótima opção para tratamento de cavidades anoftálmicas congênitas ou adquiridas, assim como realizado como procedimento primário ou secundário, em cavidades com ou sem contração tecidual. Os resultados são encorajadores e as complicações são pouco frequentes.

Dermis-fat graft for anophthalmic socket reconstruction: indications and outcomes.

PURPOSE: To evaluate the outcomes of dermis-fat graft procedure for orbital volume replacement in anophthalmic socket. METHODS: A retrospective chart review was performed studying all dermis-fat graft surgeries done at King Khlaed Eye Specialist Hospital in the last 10-year period. Sixty-two anophthalmic socket carriers underwent dermis-fat graft during the study period. Data were collected on characteristics of the patients, postoperative complications, cosmesis, and functional results such as the ability to hold an external prosthesis. RESULTS: Mean age of the patients included in the study was 34.2 ± 9.7 years. There were 38.7% of patients with grade 3 anophthalmic socket, 64.5% of patients had an acquired anophthalmic socket, and dermis-fat graft was performed as a secondary procedure in 61.3% of patients. Postoperative complications included lagophthalmos (22.6%), graft necrosis (17.7%), pyogenic granuloma (12.9%), decreased graft size (12.9%), malpositioned lids (3.2%), and volume deficiency (3.2%). The prosthesis was held in place in 49 patients (79%) preoperatively and in 55 patients (88.7%) postoperatively. CONCLUSION: Dermis-fat graft is an excellent option for congenital or acquired as well as primary or secondary anophthalmic sockets, with or without contraction. The outcomes are favorable, and complications are rare.