Periorbital reconstruction with adjacent-tissue skin grafts

BACKGROUND. Reconstruction in the periorbital area is challenging owing to the complex function of the eye, relative lack of adjacent loose tissue, free anatomic margin, central facial location, and the need to maintain symmetry with the contralateral eye. Reconstructive options risk crossing anatomic margins, deviation of the lid margin (ectropion), persistent lymphedema, and repair with skin of dissimilar color, texture, and thickness. OBJECTIVE. The purpose was to describe a reconstructive option that would avoid crossing cosmetic units or subunits, minimize the risk of ectropion, repair with tissue of similar surface characteristics, and maintain function and symmetry with the contralateral side. METHODS. The adjacent-tissue skin graft provides closure in cosmetic units and subunits, avoids tension on the lid margin, and provides similar skin for repair. The procedure is demonstrated by graphic and photographic examples. RESULTS. The procedure provides for esthetic repair of the periorbital area and minimizes the risk of ectropion, lymphedema, asymmetry, and dysfunction of the lids and lacrimal system. CONCLUSION. Adjacent-tissue skin grafts are a useful alternative for reconstruction of partial-thickness defects on the eyelid and periorbital area.