Reversible Marginal Tarsorrhaphy: A Salvage Procedure for Periocular Burns

Management of the burned eyelid can provide challenges in both the acute and reconstructive burn periods. Suboptimal eyelid burn management can result in potentially devastating complications including severe eyelid contracture, ectropion, corneal ulceration, and even vision loss.1–3 Tarsorrhaphy was once considered to be part of the management of extensive eyelid burns.1,2 However, traditional tarsorrhaphy techniques traumatized the eyelids and resulted in further complications.2 With the advent of early excision and grafting, tarsorrhaphy became taboo in the management of eyelid burns and is now an uncommon procedure. Spencer et al. reviewed 65 patients with eyelid burns and reported only four treated with tarsorrhaphy.4 Current eyelid management protocols include aggressive lubrication in the days following injury and timely excision and skin grafting with thick split-thickness or full-thickness skin grafts.3,5–7 In addition, aggressive treatment of ectropion with repeated grafting is also part of modern eyelid burn protocols.8 However, in a small number of patients, despite rigorous adherence to these principles, conjunctivitis and exposure keratopathy can still develop for a number of reasons. Patients with severe facial burns often have large total body surface areas burned and therefore require a prolonged intensive care unit course with periods of medical instability that may prevent timely return to the operating room. In addition, these patients may require prolonged periods of sedation that may inhibit their ability to protect their own corneas. The development of less invasive tarsorrhaphy techniques that are relatively easy to perform and easily reversed9–13 has renewed interest in the adjunctive use of tarsorrhaphy in the management of facial burns for the small number of patients who develop conjunctivitis or corneal ulceration. The purpose of this study was to review our experience using a reversible marginal tarsorrhaphy technique to salvage the situation when standard care fails.

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