Re: “Use of Cyanoacrylate Glue Casting for Stabilization of Periocular Skin Grafts and Flaps”
Different methods1,4–7 (Table) have been introduced to secure periocular skin grafts and flaps to lead to a better survival and cosmesis. After obtaining institutional review board (IRB) approval, chart review of our cases with periocular skin grafts and flaps mainly because of trauma and tumors was performed from March 2003 to September 2016. There were 327 procedures in the teaching hospital and senior author’s (M.B.K.) private clinic all of which were secured by the mean of quilting sutures in which 5-0 (for facial skin grafts) and 6-0 (for eyelid and canthal skin graft) vicryl sutures were used (Fig.). They were removed between 1 and 2 weeks after the procedure. No graft failure was observed except for partial graft necrosis in 3 (0.9%) cases mainly due to an underlying extensive facial burn and tissue ischemia. We believe that 7 main essentials should be taken into consideration on performing any periocular skin graft procedure: 1) Immobilizing the graft to maximize recipient–donor contact for a better vascularization (addressed in all methods); 2) preventing accumulation of hematoma and seroma under the graft (addressed in tie-over dressing and quilting sutures) to ease the vascularization; 3) avoiding too much pressure on top of the graft (seen in tie-over dressing) which may cause ischemia; 4) avoiding any eye irritation which may happen by spillover of cyanoacrylate or edge of dressing and adhesive tape; 5) avoiding unnecessary closure of the eye (observed in tie-over dressing and frost suture) to have a faster visual recovery and consequently a better quality of life; 6) being able to shape the graft like making crease on upper and lower eyelid and concavity of the medial canthal area (potential of quilting sutures); and 7) allowing direct visualization of the graft for early detection of possible complications like hematoma.
While each method (Table) addresses some of above-mentioned fundamentals, quilting sutures technique, we believe, addresses all of them leading to a better skin graft survival. Therefore, we strongly recommend this method for any facial and especially periocular skin grafts and flaps.