Ophthalmic plastic applications of acellular dermal allografts.
OBJECTIVE
Clinical problems of contracted conjunctival fornices, superior sulcus defects, and soft tissue contour defects in the periorbital region have not shown good, sustained results with a range of autologous and alloplastic implants. AlloDerm (Lifecell Corp., Woodlands, TX) is an acellular dermal graft processed from human donor tissue. The authors sought to assess the efficacy of AlloDerm as a soft tissue replacement in a variety of oculoplastic applications.


METHODS
Retrospective, noncomparative case series.


METHODS
Twenty-three patients.


METHODS
Applications were broadly classified as barrier/scaffolding (i.e., primary and secondary implant coverage, lid spacer graft) and volume augmentation (i.e., superior sulcus and other periorbital soft tissue contour defects). Barrier grafts were applied as single sheets. Stacked sheets or rolled grafts were used for augmentation. Collectively, this material was used in 29 cases with 3 to 16 months' follow-up.


METHODS
Clinical evaluation of outcome and complications.


RESULTS
As a soft tissue scaffolding and barrier implant, AlloDerm persisted sufficiently to permit repopulation with native tissue. Rolled/stacked implants demonstrated unpredictable resorption. Upper eyelid grafts seemed to have higher resorption rates than lower eyelid grafts. One case of anophthalmic superior sulcus augmentation required two revision surgeries to provide sufficient volume augmentation. The grafts were well tolerated, with no cases of infection or explanation.


CONCLUSIONS
Acellular human dermis is an excellent barrier and reconstructive grafting material that provides an alternative to autologous grafts and other alloplastic material, avoids harvesting autologous tissue, possesses excellent handling properties, and is associated with minimal inflammation. Long-term follow-up is required to evaluate persistence.
Rubin
P A
PA
Ophthalmic Plastics, Orbital, and Cosmetic Eyelid Surgery, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston 02114, USA. peter_rubin@meei.harvard.edu
Fay
A M
AM
Remulla
H D
HD
Maus
M
M
D020099:Coated Materials, Biocompatible; D005128:Eye Diseases / Q000601:surgery*; D005143:Eyelids / Q000601:surgery; D006801:Humans; D013508:Ophthalmologic Surgical Procedures / Q000379:methods*; D020273:Orbital Implants; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D016038:Skin Transplantation; D013518:Surgery, Plastic / Q000379:methods*; D014184:Transplantation, Homologous
D020099:Coated Materials, Biocompatible