To report outcomes of periocular full-thickness skin grafting using Tisseel.

Retrospective audit of all patients receiving full-thickness grafts under care of a single surgeon in 4-year period. Early and late complications were noted, particularly hypertrophy/contracture requiring revision. Cosmetic outcomes were graded by a predetermined scheme.

59 patients underwent 63 skin grafts. Indications comprised reconstruction after Mohs’ (67%) or conventional tumour surgery (19%); cicatricial ectropion (13%) and trauma (1%). Sites included lower lid (41 cases/65%); upper lid (9 cases/14%), and medial canthus (11 cases/17%). 52% of the lid defects were larger than half of the respective lid. Tisseel was applied after suture anchoring of graft and simple dressings were maintained for 1-8 (mean: 5) days. Early complications (< 30 days) comprised wound infection (3 cases/5%), haematoma (4 cases/6%) and partial edge dehiscence (4 cases/6%). No graft failed. In the medium term 19/41 (46%) lower lid grafts developed secondary ectropion, however in 14/19 this improved after massage only, with full symptom resolution. 3/19 patients had further grafting for ectropion; 2 declined revision. Graft hypertrophy was noted in 10/63 (16%) during follow-up. In 6/10 this improved without treatment to the extent where there was no cosmetic issue; 4 were revised. Final cosmesis was deemed good or excellent in 71%, with mean follow-up of 14 +/- 13 (range: 1-44) months.

Final outcomes are similar to other reported data. Sutured bolsters are not necessary despite lid movement. Tisseel appears safe to use in the periocular region and may improve graft survival.