Revascularization of Free Skin Grafts Overlying Modified Hughes Tarsoconjunctival Flaps Monitored Using Laser-Based Techniques

Purpose: It has recently been shown that the flap pedicle does not supply blood to a tarsoconjunctival graft in the modified Hughes procedure in patients. This raises questions concerning the rate of revascularization of the free skin graft commonly used to reconstruct the anterior lamella. The aim of this study was, thus, to monitor the course of revascularization in free skin grafts overlying modified Hughes tarsoconjunctival flaps, using laser-based techniques. Methods: Free skin grafts from the upper eyelid or upper arm in 9 patients were used to cover a tarsoconjunctival flap according to the modified Hughes procedure. Blood perfusion was monitored using laser speckle contrast imaging, and vascular reactivity was studied with laser Doppler velocimetry after heating the tissue to 44°C. Measurements were made at the time of surgery (baseline) and at 1, 3, 8, and 16 weeks postoperatively. Results: The gradual increase in perfusion of the free skin grafts during the healing process indicates revascularization. A slight increase in perfusion was seen already after 1 week. Perfusion reached 50% of the baseline after 3 weeks, and complete restoration of perfusion was seen after 8 weeks. The vascular function monitored with heat-induced hyperemia increased in a similar fashion. Conclusions: Full-thickness skin grafts revascularize within 3 to 8 weeks, despite overlying a tarsoconjunctival flap, which has recently been reported to be avascular. This provides further evidence that it should be possible to repair large eyelid defects using free full-thickness eyelid grafts. Accepted for publication October 23, 2018. Supported by the Swedish Government Grant for Clinical Research, the European Union's Horizon 2020 programme for Research and Innovation, Skåne University Hospital Research Grants, Skåne County Council Research Grants, Crown Princess Margaret's Foundation, the Foundation for the Visually Impaired in the County of Malmöhus, The Nordmark Foundation for Eye Diseases at Skåne University Hospital, the Diabetes Society of South-West Skåne, and the Swedish Eye Foundation. The authors have no financial or conflicts of interest to disclose. Address correspondence and reprint requests to Malin Malmsjö, M.D., Ph.D., Skånes University Hospital, 2nd Floor, Kioskgatan 1, SE-221 85 Lund, Sweden. E-mail malin.malmsjo@med.lu.se © 2019 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

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