Hard Palate and Free Tarsal Grafts as Posterior Lamella Substitutes in Upper Lid Surgery

ObjectivesTo present the surgical outcomes and postoperative complications in a series of patients who underwent upper lid surgery using autogenous hard palate grafts (HPGs) or free tarsal grafts (FTGs) as posterior lamella replacement material.DesignRetrospective, comparative, interventional case series.PatientsThirty-one consecutive patients who were operated in 2 oculoplastics centers between July 2000 and January 2005.MethodsAll patients’ clinical records were reviewed.Main Outcome MeasuresPostoperative upper eyelid contour and viability, ocular discomfort, keratopathy, and corneal edema, as well as assessment for donor site complications and final graft dimensions.ResultsThere were 31 patients who underwent upper lid surgery (15 HPGs, 16 FTGs). The complications in the HPG group included corneal edema or transient keratopathy (13.3%), partial graft dehiscence (13.3%), upper lid retraction (13.3%), and necrosis of the overlying skin flap (6.7%). There were no significant postoperative complications in the FTG group during a mean follow-up period of 13.5±5 months. Donor site complications included 2 cases of mild upper lid retraction and central peaking. There were an average of 17% decrease in FTG vertical height and a 24% decrease in HPG vertical height during the follow-up period.ConclusionHard palate grafts may be associated with a higher rate of complications in upper lid surgery relative to FTGs, although most complications are temporary. Graft contraction could be reduced by oversizing.