Periocular surgery and the impact of split-thickness skin grafts

Oculoplastic surgery has to consider the specific characteristics of the periocular region and possible resulting functional consequences. Motility of eyelids, limited skin thickness with excellent wound healing conditions, lacrimal duct system and eyelid ligaments are important criteria for the individual choice of the surgical procedure. The use of split-thickness skin grafts represents an established method to repair periocular defects. Important medical conditions for split-thickness transplantation are colour of the skin, skin structure, photodamage of the skin, hair growth and other degenerative disorders. The recipient area should be treated as carefully as possible with diathermia until the bare area is completely dry. It is important that the size of the graft is slightly larger than the area to be covered because of postoperative shrinking. Small grafts tend to result in contraction which may lead to a defective position of the eyelids. For postoperative wound maintenance, gauze containing vaseline and wool wax can be used. This helps to keep the graft smooth and to prevent its detachment upon changes of dressing. Frequency and scope of complications are similar to flap surgery if adequate individual indications for split-thickness skin grafts are considered. Early onset complications are wound dehiscence, bleeding, formation of seroma, dislocation or loss of grafted skin. The postoperative maintenance of the donor site can be managed successfully with hydrocolloid dressing. Split-thickness skin grafts represent a good reconstruction technique if other tissue (full-thickness skin) from the periocular region is not available or whenever other surgical methods appear to be less promising or inapplicable. If available, ipsi- or contralateral full-thickness skin grafts are preferred because of the same skin type.