Free Tarsoconjunctival Grafts and Composite Grafts

  • Gil A. Epstein


Free tarsoconjunctival and full-thickness composite grafts are utilized in reconstructing eyelids in which defects may be due to tumor removal, trauma, or congenital coloboma.1,2,3 These grafts may be utilized in conjunction with other types of flaps or grafts.

Free tarsoconjunctival grafts are usually harvested from an upper lid in which there is more tarsal tissue with which to work. The donor site necessitates vascular tissue (skin and orbicularis) to support nourishment to the graft. An advantage to the more commonly used tarsoconjunctival flaps is that it is a one-stage procedure.

Composite grafts are used to reconstruct large eyelid defects most commonly in an upper lid but may also be utilized in lower lid reconstruction. Advantages to a composite graft are eyelash preservation and it being a one-stage procedure. Composite grafting necessitates a nutrient vascular source from surrounding skin and orbicularis.


Free tarsoconjunctival graft Full-thickness composite graft Eyelid defect Tumor removal Trauma Congenital coloboma 

Supplementary material

419986_5_En_42_MOESM1_ESM.mp4 (74.2 mb)
Video 42.1 Harvesting of a free tarsal graft. Courtesy of Richard C. Allen, MD, PhD, FACS. (MP4 76000 kb)
419986_5_En_42_MOESM2_ESM.mp4 (205.2 mb)
Video 42.2 Free tarsal graft for repair of central lower lid defect. Courtesy of Richard C. Allen, MD, PhD, FACS. (MP4 210084 kb)


  1. 1.
    Putterman AM. Viable composite grafting in eyelid reconstruction. Am J Ophthalmol. 1978;85:237.CrossRefPubMedGoogle Scholar
  2. 2.
    Tenzel RR. Lid reconstruction. In: Smith BC, Della Rocca RC, Nesi FA, Lisman RD, editors. Ophthalmic plastic and reconstructive surgery. St. Louis: C.V. Mosby; 1987.Google Scholar
  3. 3.
    Bergin DJ, McCord CD. Reconstruction of the upper eyelid major defects. In: Hornblass A, editor. Oculoplastic, orbital and reconstructive surgery. Baltimore: Williams and Wilkins; 1988.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Gil A. Epstein
    • 1
  1. 1.Ophthalmic Plastic Reconstructive SurgeryFt. Lauderdale Eye Institute, Baptist Eye Surgery, Nova Southeastern UniversityFort LauderdaleUSA

Personalised recommendations