Full-Thickness Eyelid Wedge Replantation Following Avulsion From a Human Bite

An 18-year-old male presented with an eyelid injury following a human bite. Examination demonstrated a right upper eyelid, full-thickness, wedge-shaped defect involving approximately one-third of the eyelid length and a right upper eyelid, canalicular-involving laceration (Fig. 1A). The avulsed eyelid wedge, measuring 1.5 × 0.8 cm, had been wrapped in saline-moistened gauze and placed in a plastic bag atop ice (Fig. 2A).FIG. 1FIG. 2Surgical repair was performed 5 hours postinjury. The avulsed tissue was soaked in 5% povidone-iodine then gentamicin solution in preparation. Autograft replantation (Fig. 2B) was achieved at the medial aspect of the defect with vertical mattress sutures at the meibomian gland orifices and eyelash follicles, partial-thickness interrupted sutures through tarsus, and simple interrupted sutures through skin (Fig. 2C); this process was repeated laterally. Subsequently, the right upper punctum was dilated. A Mini-Monoka stent was placed through the punctum and advanced through the cut end of the superior canaliculus. Finally, the margin-involving canalicular laceration was repaired in a stepwise fashion, approximating the canaliculus and overlying skin. Immediately (Fig. 1B) and 6 months postoperatively (Fig. 1C), the patient had appropriate eyelid contour and closure; there were no cilia at the replant site. Timely replantation of appropriately preserved, traumatically avulsed eyelid tissue may provide a successful cosmetic and functional outcome; possible complications include graft necrosis, madarosis, eyelid retraction, and eyelid function compromise. Loss of cilia may occur secondary to crush injury to the hair follicles or may ensue following disruption of tissue perfusion in the setting of high follicular metabolic demand. Bilamellar autografts, with the contralateral eye as a donor site, offer promise for reconstruction of full-thickness, margin-involving defects.