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Yan Y, Ji Q, Yang J, Yin X, Liu S, Karalkin PA, Reshetov IV, Han D, Li Q, Huang RL. Bioengineering autologous cartilage grafts for functional posterior lamellar eyelid reconstruction: A preliminary study in rabbits. Acta Biomater 2024; 179:106-120. [PMID: 38561072 DOI: 10.1016/j.actbio.2024.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 03/12/2024] [Accepted: 03/26/2024] [Indexed: 04/04/2024]
Abstract
The reconstruction of posterior lamellar eyelid defects remains a significant challenge in clinical practice due to anatomical complexity, specialized function, and aesthetic concerns. The ideal substitute for the posterior lamellar should replicate the native tarsoconjunctival tissue, providing both mechanical support for the eyelids and a smooth surface for the globe after implantation. In this study, we present an innovative approach utilizing tissue-engineered cartilage (TEC) grafts generated from rabbit auricular chondrocytes and a commercialized type I collagen sponge to reconstruct critical-sized posterior lamellar defects in rabbits. The TEC grafts demonstrated remarkable mechanical strength and maintained a stable cartilaginous phenotype both in vitro and at 6 months post-implantation in immunodeficient mice. When employed as autografts to reconstruct tarsal plate defects in rabbits' upper eyelids, these TEC grafts successfully restored normal eyelid morphology, facilitated smooth eyelid movement, and preserved the histological structure of the conjunctival epithelium. When applied in bilayered tarsoconjunctival defect reconstruction, these TEC grafts not only maintained the normal contour of the upper eyelid but also supported conjunctival epithelial cell migration and growth from the defect margin towards the centre. These findings highlight that auricular chondrocyte-based TEC grafts hold great promise as potential candidates for clinical posterior lamellar reconstruction. STATEMENT OF SIGNIFICANCE: The complex structure and function of the posterior lamellar eyelid continue to be significant challenges for clinical reconstructive surgeries. In this study, we utilized autologous auricular chondrocyte-based TEC grafts for posterior lamellar eyelid reconstruction in a preclinical rabbit model. The TEC grafts exhibited native cartilaginous histomorphology and comparable mechanical strength to those of the native human tarsal plate. In rabbit models with either tarsal plate defects alone or bilayered tarsoconjunctival defects, TEC grafts successfully restored the normal eyelid contour and movement, as well as supported preservation and growth of conjunctival epithelium. This is the first study to demonstrate autologous TEC grafts can be employed for repairing tarsal plate defects, thereby offering an alternative therapeutic approach for treating posterior lamellar defects in clinic settings.
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Affiliation(s)
- Yuxin Yan
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, China; Shanghai Institute for Plastic and Reconstructive Surgery, Shanghai 200011, China
| | - Qiumei Ji
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, China; Shanghai Institute for Plastic and Reconstructive Surgery, Shanghai 200011, China
| | - Jing Yang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, China; Shanghai Institute for Plastic and Reconstructive Surgery, Shanghai 200011, China
| | - Xiya Yin
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, China; Shanghai Institute for Plastic and Reconstructive Surgery, Shanghai 200011, China; Department of Plastic and Burn Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Shengnan Liu
- Department of Oral Pathology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Pavel A Karalkin
- Institute of Cluster Oncology, Sechenov First Moscow State Medical University, Moscow 127473, Russia
| | - Igor V Reshetov
- Institute of Cluster Oncology, Sechenov First Moscow State Medical University, Moscow 127473, Russia
| | - Dong Han
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, China; Shanghai Institute for Plastic and Reconstructive Surgery, Shanghai 200011, China.
| | - Qingfeng Li
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, China; Shanghai Institute for Plastic and Reconstructive Surgery, Shanghai 200011, China.
| | - Ru-Lin Huang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, China; Shanghai Institute for Plastic and Reconstructive Surgery, Shanghai 200011, China.
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Yolcu D. Post-oncological full-thickness eyelid defect reconstruction: An aesthetical overview. J Craniomaxillofac Surg 2023; 51:614-620. [PMID: 37704507 DOI: 10.1016/j.jcms.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/09/2023] [Accepted: 09/05/2023] [Indexed: 09/15/2023] Open
Abstract
Purpose of the current study was to introduce a new detailed aesthetical subunit (ASU) involvement chart to localize the defect configuration on the eyelids, and, to evaluate the aesthetical and functional outcomes of the post-oncological full-thickness eyelid defect reconstruction surgery by using a modified aesthetical rating guideline. Medical records of subjects who were diagnosed with a primary malignant full thickness eyelid tumor involving the eyelid margin and underwent full-thickness eyelid defect reconstruction surgery between April 2016 and May 2022 were retrospectively reviewed. Age, sex, pathological diagnosis, follow-up time, the ASU of the eyelid involvement, and surgical methods used to reconstruct the anterior and posterior lamella were examined from medical records. The reconstructed eyelid photos were scored according to the modified aesthetical rating guideline to analyze the aesthetical and functional outcomes of the surgeries. A total of 31 subjects were included to the study, and the overall mean aesthetical score was 3.5. Seventeen subjects with aesthetical scores greater than 3.5 were included in the more aesthetically pleasing (AP) group, and 14 subjects with aesthetical score less than 3.5 were included in less AP group. Anterior lamella repair was mainly performed using myo-cutaneous flaps in the more AP group and multiple flap combinations in the less AP group (P: 0.13). Posterior lamella reconstruction was performed using tarso-conjunctival tissue in both groups. In more AP group, tissue scarring, lash line disruption, eyelid thickness, and retraction or ectropion scores were significantly higher when compared with less AP group (P:0.03, P:0.03, P:0.02, and P:0.01, respectively). Subjects with fair eyelash color were significantly more common in more AP group (P: 0.009). The ASU involvement chart and outcomes of the current study may aid novice surgeons to determine which method will provide the best result for an individual patient for full-thickness eyelid defect repair and may offer some insight into the different surgical techniques used for repairing similar wounds.
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Affiliation(s)
- Demet Yolcu
- University of Health Sciences, Abdurrahman Yurtaslan Oncology Training and Research Hospital, Department of Ophthalmology, Demetevler, Vatan Cd., Yenimahalle, 06200, Ankara, Turkey.
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Mozo Cuadrado M, de Oliveira A, Procianoy F. Limited vertical tarsal resection in a case of basal cell carcinoma of the lower eyelid. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2023; 98:540-543. [PMID: 37353072 DOI: 10.1016/j.oftale.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/15/2023] [Indexed: 06/25/2023]
Abstract
We present the clinical case of a 71-year-old woman with a history of multiple basal cell carcinomas (BCC) who presented a nodular lesion in practically the entire extension of the free edge of the lower eyelid. The lesion was approached by excision of the palpebral margin with limited vertical resection of the tarsus and Tripier flap with a correct aesthetic and functional result, free histological margins and no recurrence in a 12-month follow-up.
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Affiliation(s)
- M Mozo Cuadrado
- F.E.A. Oftalmología. Hospital Universitario de Navarra, Spain.
| | - A de Oliveira
- Fellow de Oculoplástica do Serviço de Oftalmologia do Hospital de Clínicas de Porto Alegre (HCPA), Brazil
| | - F Procianoy
- Chefe do Setor de Oculoplástica do Serviço de Oftalmologia do Hospital de Clínicas de Porto Alegre (HCPA)/Universidade Federal do Rio Grande do Sul, Brazil
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Yan Y, Fu R, Ji Q, Liu C, Yang J, Yin X, Oranges CM, Li Q, Huang RL. Surgical Strategies for Eyelid Defect Reconstruction: A Review on Principles and Techniques. Ophthalmol Ther 2022; 11:1383-1408. [PMID: 35690707 PMCID: PMC9253217 DOI: 10.1007/s40123-022-00533-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 05/23/2022] [Indexed: 02/08/2023] Open
Abstract
Reconstruction of eyelid defects, especially the posterior lamella, remains challenging because of its anatomical complexity, functional considerations, and aesthetic concerns. The goals of eyelid reconstruction include restoring eyelid structure and function and achieving an aesthetically acceptable appearance. An in-depth understanding of the complex eyelid anatomy and several reconstructive principles are mandatory to achieve these goals. Currently, there are multiple surgical treatment options for eyelid reconstruction, including different flaps, grafts, and combinations of them. This comprehensive review outlines the principles of reconstruction and discusses the indications, advantages, and disadvantages of currently available surgical techniques. We also propose our clinical thinking for solving specific clinical questions in eyelid reconstruction and offer perspectives on new potential methodologies in the future.
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Affiliation(s)
- Yuxin Yan
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Rao Fu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Qiumei Ji
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Chuanqi Liu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China.,Department of Plastic and Burn Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Yang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Xiya Yin
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China.,Department of Plastic and Burn Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Carlo M Oranges
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Qingfeng Li
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China.
| | - Ru-Lin Huang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China.
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