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Composite grafts in eyelid reconstruction: the complications and outcomes
  1. Paul S Cannon1,
  2. Simon N Madge1,
  3. Hirohiko Kakizaki2,
  4. Dinesh Selva1
  1. 1Discipline of Ophthalmology & Visual Sciences, University of Adelaide & South Australian Institute of Ophthalmology, Adelaide, Australia
  2. 2Department of Ophthalmology, Aichi Medical University, Nagakute, Aichi, Japan
  1. Correspondence to Dr Paul S Cannon, Discipline of Ophthalmology & Visual Sciences, University of Adelaide & South Australian Institute of Ophthalmology, Adelaide, SA 5000, Australia; pscan05{at}


Aims To describe the outcomes and complications for composite eyelid grafts in a large case series over a 9-year period.

Method A retrospective study of all patients who underwent a composite graft for eyelid reconstruction between January 2000 and May 2009. A composite eyelid graft involves the excision of a full thickness pentagonal wedge from the donor eyelid, which is inserted into the recipient eyelid defect. The orbicularis muscle is discarded from the composite graft. Initial diagnosis, complications, postoperative eyelid contour and colour were recorded.

Results Forty-two patients were identified in the study period; the mean age was 69 years. Reconstruction following basal cell carcinoma excision was the commonest indication for surgery. Thirty-five composite grafts were performed for lower eyelid defects and seven for upper lid defects. The average size of the grafts was 9.1 (range 7–12) mm. Five patients required two grafts to reconstruct the defect. Thirty-six (86%) patients achieved a satisfactory contour and 33 (78%) patients had good matching skin colour. Partial dehiscence occurred in five patients and three patients had bulkiness of the graft postoperatively. We had no episodes of graft failure, although two patients had skin necrosis, which resolved.

Conclusion Composite eyelid grafts when combined with mobilisation of the recipient orbicularis muscle can result in good preservation of eyelid function with satisfactory cosmesis.

  • Composite eyelid grafts
  • complications
  • graft survival
  • eyelid contour
  • eyelid skin colour
  • eye lids
  • wound healing
  • neoplasia
  • treatment surgery

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  • Funding Dr Paul S Cannon received funding from the Royal College of Ophthalmologists, the Dickinson Trust, Pfizer and the Ethicon Foundation for Ophthalmic Fellowship training in Adelaide. These sponsors had no role in the design or conduct of this study.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the local institutional review board.

  • Provenance and peer review Not commissioned; externally peer reviewed.