Purpose

To describe a novel reconstructive technique using Tutoplast (Gamma sterilised dehydrated human pericardium) and frozen amniotic membrane grafting for a recurrent periocular basal cell carcinoma (BCC) in a patient with limited donor tissue options.

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Methods

An 83-year-old woman with multifocal and refractory periocular right lower lid BCC had undergone three excision and reconstruction of right lower lid over past 6 years. Reconstructions previously included contralateral upper eyelid and post-auricular skin grafts. Following a fourth occurrence involving the lower eyelid, a wide tumour excision created a 10 × 23 mm full-thickness lower lid defect. There was paucity of healthy autologous skin for grafting due to new facial BCCs as well as previous facial reconstructive surgeries for BCCs. Hence, posterior lamella was replaced using Tutoplast graft and an amniotic membrane (3×3 cm frozen) was sutured to the adjacent tumour free skin covering Tutoplast anteriorly. A Kaltostat dressing was then sutured to bolster the amniotic membrane.

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Results

Postoperative recovery was uncomplicated with satisfactory graft integration. At 4 weeks, lid contour and stability were maintained with minimal lagophthalmos of 0.5 mm and no corneal exposure. By 3 months, lagophthalmos had resolved completely with stable ocular surface protection and satisfactory anatomical outcome.

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Conclusion

Combined Tutoplast and amniotic membrane grafting provided successful functional and cosmetic reconstruction in this challenging periocular reconstruction post BCC excision. This technique may represent a valuable alternative in complex periocular oncological reconstruction.

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Additional Authors

First name	Last name	Base Hospital / Institution
Rina	Bhatt	The Royal Wolverhampton NHS Trust

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