Two-stage spacer plastics with free skin graft, meshwork for hernioplasty and autologous lip mucosa for lower eyelid repair: a three-side approach

We present a case of repair of posttraumatic lower eyelid retraction with tissue loss and scarring after blunt trauma of the eye with a fracture of the inferior orbital wall. Attempted reconstruction of zygomatico-orbital region with titanium meshwork resulted in rejection of the meshwork and contraction of cutaneous-muscular and tarso-conjunctival layers. A two-stage surgical technique of lower eyelid retraction repair with full-thickness skin autograft from preauricular face zone using a spacer out of Ultrapro composite monofilament meshwork and autologous mucosa of the lip was used. At the first step deep scars were resected and lost volume of skin tissue was restored. At the second step spacer grafts were used for supporting purposes to provide structural support. As a result, vertical size of the lower eyelid was elongated in relation to the eyeball by 2.88 mm. In one year after surgery there was no significant difference in the distance between lower limbus and lower eyelid on both sides. There was good and stable functional and aesthetic result of surgery. This surgical approach gave a possibility to dose the effect of operation, to repair retraction of the lower eyelid, to restore an adequate adaptation of the eyelids and to reduce the vertical size of the eye slit without sufficient change of its horizontal size as well as to prevent keratopathy. Key words: lower eyelid retraction, ectropion, entropion, spacer graft