Reply re: “Use of Cyanoacrylate Glue Casting for Stabilization of Periocular Skin Grafts and Flaps”

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I thank Kashkouli et al.1 for their very well thought out comments on facial and periocular skin grafting techniques and principles. I agree there is a role for many of the cadre of skin grafting techniques depending on the individual situation facing the oculofacial surgeon. I myself use many of the techniques, including quilting sutures, depending on defect size and location. I however find cyanoacrylate casting alone particularly useful for small- to medium-sized grafts and flaps of particularly the lower eyelid. The technique allows for excellent immobilization, vision preservation secondary to lack of patching, avoidance of pressure ischemia, ability to directly visualize the graft and monitor for graft complications, and avoidance of any eye irritation if the surgeon takes care to apply the glue precisely. Subgraft hematoma is obviously a concern without a pressure bolster; however, in small to medium grafts with attention to meticulous hemostasis, I have not seen this complication in over 20 cases. The thin nature of these small grafts in this location make them particularly robust and perhaps more likely to remain viable even with small subgraft fluid accumulations. Additionally, I theorize that the cyanoacrylate not only immobilizes the surrounding tissue but also the graft–host interface thus collapsing a portion of the subgraft potential space. These factors likely contribute to the success of the technique in these selected cases.
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