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Since 1986, we have used external wire frame fixation of eyelid skin graft in 24 cases. In 1991, we reported this method and described two of its advantages.
Since publication of the paper, we have found another advantage in the case of eyelid graft, especially for the lower eyelid.
The wire frame fixation technique is explained as follows (Fig. 1) . The skin graft is fixed with sutures in the usual way (A). Then, a wire frame with the outline of the graft is made of 1 mm diameter Kirschner wire (B). Next, the wire frame is attached with sutures used for stitching the graft (C). Finally, tie-over fixation is performed in the usual way (D).
Figure 1Method of tie-over fixation with an external wire frame (Br J Plast Surg 1991; 44: 69).
A 27-year-old female suffered from an extensive frame burn. After emergency skin grafting, severe contractures occurred in the bilateral lower eyelids. Therefore, full-thickness skin grafts with external wire frame fixations were performed for the lower eyelids after releasing the scar contractures. After removing the tie-over, the skin grafts were taken completely. Furthermore, her eyes opened partially because tarsorrhaphies were not necessary (Fig. 2) .
Figure 2External wire frame fixation of eyelid graft.
In the case of skin grafting on the eyelid, a temporary tarsorrhaphy must be used for the appropriate tension of a recipient bed and proper contact between a skin graft and its recipient bed. However, the patient is inconvenienced, because it is impossible to open the eye due to the tarsorrhaphy, especially in the case of bilateral tarsorrhaphies. External wire frame fixation of eyelid graft overcomes this disadvantage of tarsorrhaphy.
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