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Complex facial lacerations are frequently encountered in the combat environment. Trauma with soft-tissue loss of the periorbital region offers particular challenges in terms of operative reconstruction. Cicatricial changes in the sub-acute phase can lead to eyelid malposition and lagophthalmos. The authors present a novel technique for acute reconstruction of periorbital trauma with eyelid soft-tissue loss with simultaneous full-thickness skin grafting and amniotic membrane grafting. The technique involves standard preparation of the surgical area of injury and infiltration with local anesthetic. Initially, the area of injury is copiously irrigated, and debridement of any necrotic tissue is accomplished. Amniotic membrane grafting is then performed over the defect. Approximately 2 mm × 2 mm full-thickness skin grafts are procured and distributed over the initial amniotic membrane graft. A second amniotic membrane graft is then secured over the skin graft-amniotic membrane graft complex with cyanoacrylate tissue adhesive. A bolstered suture tarsorrhaphy is performed to minimize tissue trauma during the healing process. The operative and postsurgical outcomes were assessed. The graft site healed well without cicatricial changes or lagophthalmos. Peripheral small papillomatous lesions did develop requiring excision for cosmesis, but ultimately the graft site demonstrated appropriate coverage and healthy re-epithelialization over the previous defect. This case demonstrates the viability of simultaneous full-thickness skin grafting with concomitant amniotic membrane grafting for the acute reconstruction of periorbital trauma with eyelid anterior lamella tissue loss. An excellent cosmetic and functional outcome was attained. By providing acute reconstruction, the risk of damage secondary to cicatricial periorbital changes may be avoided., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2020. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Thermal burns of the periorbital region offer a particular challenge to surgeons in terms of satisfactory operative reconstruction. Several approaches currently exist, including full-thickness skin grafting following scar excision. The authors present a novel technique for the reconstruction of periorbital thermal burns involving the anterior lamella of the eyelid with simultaneous full-thickness skin grafting and amniotic membrane grafting. A retrospective review of six patients with periorbital thermal burn injury involving the anterior lamella of the eyelid(s) who underwent operative reconstruction utilizing this technique was performed. The operative and post-surgical outcomes were evaluated. In total, sixteen graft sites were examined. All graft sites demonstrated appropriate coverage and healthy re-epithelialization over the previously necrotic and burned areas. No evidence of cicatricial changes or lagophthalmos was noted. The postoperative outcomes demonstrate excellent functionality and cosmesis. By providing acute reconstruction, the risk of ophthalmic damage and vision loss secondary to cicatricial eyelid changes may be avoided. Additionally, utilizing only a minimal amount of tissue for reconstruction preserves vital skin. This analysis demonstrates the viability of simultaneous full-thickness skin grafting and amniotic membrane grafting for the acute and sub-acute reconstruction of periorbital thermal burn injury., (Copyright © 2020 Euro-Mediterranean Council for Burns and Fire Disasters.)

Purpose: It has been demonstrated the pedicle of a tarsoconjunctival flap advancement does not appear to supply the flap itself and the vascularization of the remaining eyelid/tear film is thought to offer adequate nourishment for survival of the flap; as such, a swine model was constructed to assess the viability of a bilamellar autograft for repair of large full-thickness eyelid defects., Methods: Full-thickness defects of varying sizes were created in each lower eyelid of 4 Yorkshire/Yorkshire crossed swine. The defects were then closed with a full-thickness ipsilateral graft from the upper eyelid. Large full-thickness defects were then created in the upper and lower eyelids of 8 Yorkshire/Yorkshire crossed swine and closed with bilamellar autografts from the contralateral eyelids. The subjects were then monitored postoperatively and assessed clinically for graft viability at postoperative days 1, 7, and 30. At the conclusion of the 30-day postoperative monitoring period, necropsy was performed and histopathologic analysis utilized to assess cell morphology and vessel ingrowth of the graft sites., Results: In total, 28 full-thickness bilamellar grafts were constructed and examined. At the conclusion of the postoperative monitoring period, 27 of the grafts were deemed clinically viable and vascular ingrowth was determined to be equivalent to unaffected eyelid sections by histopathologic analysis. One case of postoperative hematoma was noted in the failed graft. One case of postoperative wound dehiscence required subsequent surgical repair. No clinically significant notching of the graft sites was noted. No cases of wound infection, corneal decompensation, or forniceal shortening were identified., Conclusions: This analysis demonstrates the viability of a full-thickness bilamellar autograft as a surgical alternative in the repair of large full-thickness eyelid defects in a porcine model. The postoperative outcomes are consistent with the recent literature. Additional studies need to be performed to assess the procedure's clinical utility in human subjects before incorporation into clinical practice.

Purpose: Watertight closure of perforating corneoscleral lacerations is necessary to prevent epithelial ingrowth, infection, and potential loss of the eye. Complex lacerations can be difficult to treat, and repair with sutures alone is often inadequate. In this study, we evaluated a potentially sutureless technology for sealing complex corneal and scleral lacerations that bonds the amniotic membrane (AM) to the wound using only green light and rose bengal dye., Methods: The AM was impregnated with rose bengal and then sealed over lacerations using green light to bond the AM to the deepithelialized corneal surface. This process was compared with suture repair of 3 laceration configurations in New Zealand White rabbits in 3 arms of the study. A fourth study arm assessed the side effect profile including viability of cells in the iris, damage to the blood-retinal barrier, retinal photoreceptors, retinal pigment epithelium, and choriocapillaris in Dutch Belted rabbits., Results: Analyses of the first 3 arms revealed a clinically insignificant increase in polymorphonuclear inflammation. In the fourth arm, iris cells appeared unaffected and no evidence of breakdown of the blood-retinal barrier was detected. The retina from green light laser-treated eyes showed normal retinal pigment epithelium, intact outer segments, and normal outer nuclear layer thickness., Conclusions: The results of these studies established that a light-activated method to cross-link AM to the cornea can be used for sealing complex penetrating wounds in the cornea and sclera with minimal inflammation or secondary effects.

Purpose: To report the use of the Boston Ocular Surface Prosthesis (BOSP) in patients with severe periorbital thermal injuries., Design: Retrospective, interventional case series., Participants: Patients with severe periorbital thermal injuries treated with the BOSP., Methods: Chart review of 10 consecutive patients (16 eyes) who sustained severe periorbital thermal injuries during combat missions in Iraq and Afghanistan and were treated for exposure keratopathy with the BOSP, a Food and Drug Administration-approved gas-permeable, scleral contact lens., Main Outcome Measures: Corneal epithelial defect healing, uncorrected and best-corrected visual acuity, and BOSP wear time., Results: Exposure keratopathy occurred after severe periorbital thermal injuries and followed a predictable course of scar contracture. In all patients, vision-threatening ocular surface disease developed as a result of chronic ocular exposure. Rehabilitation of the ocular surface was accomplished using the BOSP, with 10 of the 16 treated eyes achieving a corrected visual acuity of 20/70 or better. Five eyes achieved a best-corrected visual acuity of 20/40 or better. The BOSP also was used as a drug-delivery vehicle to treat corneal ulcers successfully in 6 eyes. The only eye that required penetrating keratoplasty was an early intervention believed to be a direct sequelae of the original thermal burn, rather than a failure of the BOSP regimen. The mean BOSP wear time was 16 hours per day., Conclusions: The BOSP can play an important role in rehabilitation of the ocular surface for patients with severe periorbital thermal injuries and resultant exposure keratopathy. Use of the BOSP should be considered as a treatment option for these difficult cases of severe periorbital thermal injuries., (Copyright © 2012 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Patients in burn intensive care units suffer from potentially life-threatening conditions including thermal or chemical burns and Stevens-Johnson syndrome/toxic epidermal necrolysis. There is often involvement of the ocular surface or adnexal structures which may be present at the time of hospital admission or may develop later in the hospital course. This article will describe the types of ocular burns, the mechanisms and manifestations of Stevens-Johnson syndrome/toxic epidermal necrolysis, the circumstances that may influence outcome, and acute and long-term treatment strategies, including new and evolving options.

Since the cornea is an avascular tissue, the wound healing process is lengthy, with a need for sutures to stabilize the wound for a long time. Platelet-derived growth factor (PDGF) has been shown to accelerate wound healing in rat dermal models. Accelerated healing, if unaccompanied by side effects may reduce suture related complications such as astigmatism and infectious keratitis. This study evaluated the effect of PDGF on wound strength in corneal laceration and penetrating keratoplasty models using New Zealand white albino rabbits. Twenty-two rabbits were used in the corneal laceration model and sixteen rabbits in the penetrating keratoplasty model. The treated rabbits received 385 picomoles/drop of PDGF-BB dissolved in balanced salt solution six times on day 1 and three times a day for the remainder of the study. The control rabbits received balanced salt solution in the same dosing schedule. The pressure required to rupture the wound was measured using a pressure transducer. In the laceration model the PDGF treated group had mean (+/- standard deviation) average pressures on day 7 of 360 +/- 102 mm Hg for wound rupture compared to 210 +/- 102 mm Hg in the control group. (p = 0.005). The average pressures in the penetrating keratoplasty model on day 17 were 707 +/- 201 mm Hg for the controls and 1042 +/- 292 mm Hg for the PDGF treated group (p = 0.026). Histopathological evaluation of eyes not subjected to bursting showed increased fibroblasts at the wound junction with an increase in types III and type IV collagen production.(ABSTRACT TRUNCATED AT 250 WORDS)