Modified full-lid transplants ("tarsomarginal transplants") in reconstructive eyelid surgery

The author first used modified full-thickness lid grafts (tarsomarginal grafts) in lid reconstruction in 1972. They consist of only conjunctiva, tarsus, and lid margin. The anterior lid lamella is rebuilt by a myocutaneous flap from the adjacent tissue. As compared to conventional full-thickness lid grafts, this reduces the risk of necrosis. No cosmetic or functional disturbance of donor eyelids was observed. In cases of total lid loss up to three tarsomarginal grafts can be inserted simultaneously. The use of modified full-thickness grafts is superior to other well-known techniques, especially in cases with defects of the medial half of the lower lid and upper lid defects, up to and including total upper lid loss, even if the tarsus in the grafts is subject to regressive changes and the lashes are usually lost.