title: Injectable 5-FU with or without added steroid in periorbital skin grafting: initial observations.
abstract: OBJECTIVE
  The authors describe their experience with postoperative injectable 5-fluorouracil (5-FU), with or without added low-dose and concentration steroid, in the particular patient subset undergoing eyelid skin grafting surgery.
  
  
  METHODS
  A retrospective chart review (2011-2013) of patients who underwent eyelid skin grafting for various etiologies with adjunctive postoperative 5-FU (50 mg/ml) injections (with or without added kenalog 5 mg/ml) was performed. Injections were given 2 to 3 weeks postsurgery and as frequently as every 2 weeks for a total of up to 4 injections. At each visit, patients were evaluated for redness, swelling, wound healing, scar formation, tissue inflammation/atrophy, telangiectasis, and pigmentary disturbances. Patient interpretation of outcome was determined subjectively by asking if they were satisfied and objectively by their separate responses to specific questions graded on a Likert-type scale. Operating surgeon satisfaction was determined only by subjective clinical evaluation of final results. Finally, a graded evaluation of pre- and postoperative digital photographs by an independent facial plastic surgeon was added to quantitatively evaluate the surgical results.
  
  
  RESULTS
  Nineteen patients with an average age of 66 years and follow up of 10 months are included. Surgical indications include reconstruction of cancer excision defects, repair of lower eyelid ectropion or retraction, benign eyelid lesion excision, and effacement of a canthal web. On average, patients had a total of 4 separate 0.3 to 0.5 ml 5-FU, or 5-FU/kenalog injections spaced 2 to 3 weeks apart. In 11 of 19 patients, the 5-FU injections were mixed with steroid. There were no cases of skin thinning, color/texture change, atrophy, telangiectasis, or infection after injection, and all patients had uneventful healing of their grafts. Eighty-nine percent of patients were satisfied with their outcome (graded 4.73/5) and the appearance of the skin graft (graded 4.79/5). In 95% of cases, the surgeon was satisfied with the surgical result. Independent surgeon assessment of outcome was graded (4.58/5).
  
  
  CONCLUSIONS
  A 5-FU or 5-FU/kenalog (75%/25%) mixture can be injected safely after eyelid skin grafting surgery. Surgical results are good with minimal scarring, high patient and surgeon satisfaction, and few complications. Results are equally efficacious and complication-free with or without the addition of a steroid component to the injection mixture.
authors.affiliation: *Facial Plastic Surgery, Spalding Drive Cosmetic Surgery and Dermatology, Beverly Hills, California; †Department of Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, University of Southern California, Los Angeles; ‡The Facial Paralysis Institute and The Center for Advanced Facial Plastic Surgery, Beverly Hills, California; §Department of Facial Plastic and Reconstructive Surgery, David Geffen School of Medicine at UCLA, Los Angeles; and ║Ophthalmic Plastic and Reconstructive Surgery, The Facial Paralysis Institute, Beverly Hills, California, U.S.A.
authors.forename: Donald B
authors.initials: DB
authors.lastname: Yoo
authors.forename: Babak
authors.initials: B
authors.lastname: Azizzadeh
authors.forename: Guy G
authors.initials: GG
authors.lastname: Massry
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019882:Blepharoplasty; D004338:Drug Combinations; D005143:Eyelids / Q000601:surgery*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage*; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007267:Injections; D008297:Male; D008875:Middle Aged; D056687:Off-Label Use; D011182:Postoperative Care; D011183:Postoperative Complications / Q000517:prevention & control; D012189:Retrospective Studies; D016038:Skin Transplantation; D014222:Triamcinolone Acetonide / Q000008:administration & dosage*; D014945:Wound Healing / Q000187:drug effects
chemical_list: D004338:Drug Combinations; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D014222:Triamcinolone Acetonide; D005472:Fluorouracil