Thirty-one patients were included in the case series: 14 females (14/31; 45%) and 17 males (17/31; 55%), with a mean age of 78-years-old (SD +- 9 years) (Table 2). Patients had a variety of comorbidities and 13 were on blood thinners, as indicated in Table 2. The average width of the tumor excision (recipient site pre-excision) was 18.8 mm (SD +- 3.0), ranging from 15 to 27 mm. The average donor site width pre-excision was 11.5 mm (SD +- 1.1 mm), ranging from 9 to 13 mm, and approximately 8-10 mm in height (Table 1). For very large recipient sites in 3 cases, a mini temporal rotation flap was also performed to help fill in the defect. A cantholysis was performed at the recipient site when the lid was under too much tension in an additional 3 cases. Two patients required a canalicular stent based on the location of their tumors. The upper eyelid was used for the ipsilateral lower lid most commonly, but also grafted to the contralateral lower or upper lid. The lower eyelid was grafted to the contralateral lower lid for one patient.
In the surgical center's region, it is not protocol for dermatopathologists to provide histopathological margin measurements for BCC. However, the reports stated that the peripheral and deep margins were negative for all patients. The case with MIS had 5 mm margins on histopathology. Radical excision was achieved in all cases.
The FBA procedure results demonstrated success with respect to structural integrity, appearance, and viability of the full-thickness composite graft. No complications occurred during the procedure. The sutures did not have to be removed and never caused friction between the lid and cornea. All patients were satisfied with the functional and cosmetic result of their surgery. In general, complications were more common in patients who had a recipient site larger than 17 mm (Table 1).
A chalazion developed in the autograft of two eyelids post-surgery, demonstrating that its Meibomian glands likely remained functional. Three patients developed mild ectropion, two of which required repair. There was initial ptosis in many patients due to shortening of the donor eyelid's horizontal length; however, this resolved over weeks. Lashes were generally lost or reduced in number on the grafted eyelid. Two patients developed cysts within or adjacent to the autograft that were inconsequential. Six patients developed minor dehiscence of the autograft, three of which were traumatic in nature due to rubbing the eye, wearing swimming goggles, and using a shield with a string post-operatively. Approximation sutures were required in five of these patients.
One patient had a recurrence of BCC at the recipient site many years after excision (Table 1). A different patient had a second primary BCC develop lateral to the excision site. One patient experienced superficial necrosis in the middle inferior aspect of the graft, after developing frostbite of the face. The graft ultimately healed but led to a mild ectropion. The patient required a temporary tarsorrhaphy due to exposure keratitis. No patients developed postoperative entropion, eyelid notching, distichiasis, trichiasis, lanugo hair irritation, donor lid contraction, dry eyes, or other complications (Table 1).
The FBA procedure heals in three observable phases: the white phase, the blue phase, and the pink phase (Figure 3). Using the pictures taken at each follow up appointment and patient feedback, it was approximated that the white phase lasted from the time of operation to between 24 and 48 h post-operation, the blue phase lasted from 24 to 48 h and 7-12 days post-surgery, and the pink stage started around day 7-12 post-surgery with visible blood vessels in the autograft. The pink colour slowly faded over weeks to months.