Outcomes of Free Tarsoconjunctival Grafts in Lower Eyelid Reconstruction Following Basal Cell Carcinoma Surgery

Abstract

The treatment of skin malignancies of the lower eyelid presents unique challenges due to the thin skin, proximity to vital structures, and the functional importance of the eyelid. Although surgical excision remains the standard approach for such malignancies, lower eyelid reconstruction is critical for preserving both function and aesthetics. Free tarsoconjunctival grafts (FTGs) have emerged as effective options for posterior lamellar reconstruction, providing structural support and long-term stability. This retrospective study analyzed cases of lower eyelid reconstruction using FTGs between December 2014 and November 2024. Eleven cases met the inclusion criteria, all of which involved basal cell carcinoma (BCC). During this period, 115 lower eyelid BCC cases were treated, and FTGs were selectively applied in 9.6% of cases. Grafts were harvested from the ipsilateral upper eyelid, with dimensions ranging from 5 to 11 mm in width and 3 to 5 mm in height. Postoperative outcomes, including complications, graft dimensions, and tumor recurrence, were evaluated. No major complications were observed. Minor complications occurred in three cases: one patient developed trichiasis at the graft site, and two patients experienced mild corneal epithelial damage. However, none of the patients reported subjective symptoms related to these complications. At a mean follow-up of 19.3 months, no tumor recurrence was observed, although one patient died of unrelated causes. These findings highlight the suitability of FTGs for small to moderately sized defects. Careful graft size selection leads to favorable outcomes with minimal complications. Overall, FTGs are a reliable and safe option for lower eyelid reconstruction, balancing oncological safety, functional preservation, and aesthetic outcomes in conservative surgical approaches for BCC treatment.