Palmaris longus tendon graft for repair of iatrogenic lateral lower eyelid defect: A method for periorbital esthetic restoration.

Abstract

Iatrogenic and traumatic eyelid defects pose considerable functional and esthetic challenges, that are often inadequately addressed by traditional reconstruction techniques. We investigated the efficacy of palmaris longus tendon grafting as a novel method for reconstructing such defects. Patients who underwent palmaris longus tendon repair at the Naval Medical Center of the Chinese People's Liberation Army (NMC-PLA) between 2021 and 2024 were evaluated. All surgeries were successfully completed with a mean operative time of 105.2±20.1 min. At 3 months follow-up, all patients (31/31) achieved full eyelid closure, and 28 of 31 patients had restored tear drainage. Dry eye symptom scores significantly improved from 7.2±1.5 preoperatively to 2.3±0.9 postoperatively (p<0.001). Reported postoperative complications, including local infection (3/31), mild pain (2/31), and transient edema (1/31), were minimal. Donor site morbidity was low (1/31). At 6 months, 29 of 31 patients maintained stable eyelid positioning. The revision surgery rate was 1/31, significantly lower than the 15-30% reported for traditional techniques (p<0.01). Overall, 28 of 31 patients reported being "very satisfied" or "satisfied" with their outcomes. Palmaris longus tendon grafting is a safe, effective, and esthetic option for reconstructing iatrogenic and traumatic eyelid defects. It offers low complication and recurrence rates, excellent functional recovery, and is especially beneficial in challenging cases where traditional methods have failed.