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Tenonplasty with oral buccal mucosal graft repairs sclerocorneal melt after chemical burn
A surgeon describes the technique and the treatment of three patients with serious chemical burns.
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A new method of tenonplasty combined with free oral buccal mucosa autografts can be used to surgically repair an intractable sclerocorneal melt caused by a serious chemical burn, according to a study.
Although various methods exist to treat chemical burns, complications and graft failures are often associated with each technique.
Buccal mucosa can be considered a substitute for the conjunctiva, and cultivated oral mucosal epithelial cells can promote epithelialization and stabilization of the ocular surface. Therefore, autologous oral mucosal membrane can be easy to harvest and may avoid the risks of allogeneic immune rejection and the need for immunosuppression. Additionally, colony-forming assays with oral mucosal epithelium show that the removed oral tissue contains epithelial stem cells or progenitor cells, the study said.
Tenonplasty, a well-established procedure, is used to regenerate the conjunctival surface and can allow a bridge for migration of conjunctival or limbus cells, but repair may be delayed after surgery because cells can be injured concomitantly, the study said.
Jie Wu, MD, and colleagues described the combined technique, published in Cornea, using the procedure in three patients with serious chemical burns.
“Tenonplasty provides nutrients, and free oral buccal mucous autograft provides seeds for repair of ocular burns, which is why we combined them,” Wu told Ocular Surgery News.
Technique
First, oral buccal mucosa was harvested from the inner lower lip of each patient. The harvested graft was trimmed manually under a microscope to remove excess submucosal fat and then stored in balanced salt solution.
The injured eye of each patient was then exposed and fixed with superior and inferior rectus sutures, and necrotic material from the surface of the sclerocorneal melt was gently removed. The conjunctival edge surrounding the area of the melt was dissected in order to make room for suturing of the oral buccal mucosa autograft.
Tenonplasty was performed by covering the ischemic sclera with healthy vascularized tissue from the depth of the orbit and then reconstructing the conjunctival matrix of the globe, up to the limbus.
Representative cases
All three serious chemical burn cases were resolved within 1 month after the combined procedure was performed, with results showing the technique to be effective in controlling sclerocorneal melts.
“Firstly, the local microenvironment and microcirculation were greatly improved by tenonplasty, which facilitated the survival and proliferation of the local cells,” Wu said.
The study authors consider this technique to be a potentially globe-saving procedure.
“Secondly, free oral buccal mucous autograft provided many cells for repair and re-epithelialization. Third, a lot of oral minor salivary glands exist in the oral buccal mucous and account for approximately half the baseline secretion of saliva. They can be transplanted together with the overlying mucosa as a complex graft to the melted sclera area and improve disorder resulting from conjunctival gland damage,” Wu said.
With no complications reported from this technique, Wu also thinks the procedure is not difficult for a surgeon to learn.
In the future, Wu said that the microenvironment of the ocular surface after surgery needs to be assessed to make this technique a norm in repairing an intractable sclerocorneal melt caused by a serious chemical burn. – by Kristie L. Kahl
- Reference:
- Wang S, et al. Cornea. 2015;doi:10.1097/ICO.0000000000000576.
- For more information:
- Jie Wu, MD, can be reached at Protomedicus, 30 Fen Road, South St, Xi’an 710000, China; email: tiannuo1979@163.com.
Disclosure: Wu reports no relevant financial disclosures.