Acellular Fish Skin Xenograft for Eyelid Reconstruction in Burns, Necrotizing Fasciitis, and Trauma

Purpose: To describe the use of an acellular fish skin (AFS) xenograft as a biologic scaffold for eyelid reconstruction in patients with scarring and tissue loss due to trauma, necrotizing fasciitis, and thermal burns. Methods: We present a novel technique for eyelid reconstruction in 4 patients using AFS following severe eyelid injuries from diverse etiologies: thermal burns (n = 2), necrotizing fasciitis (n = 1), and trauma (n = 1). Patients experienced cicatricial retraction and/or periorbital tissue loss necessitating reconstruction. AFS grafts were applied as dermal substitutes for eyelid defects. Results: In all cases, AFS was well tolerated with no evidence of graft rejection, infection, or significant inflammation. Functional outcomes, including eyelid closure and ocular surface protection, were preserved or improved in all patients. Some patients required multiple applications of AFS to address ongoing tissue contraction and cicatricial changes that occurred during the healing process. Conclusions: AFS is a safe and effective dermal substitute in eyelid reconstruction for cicatricial changes and tissue loss due to burns, infections, or trauma. Its biocompatibility and capacity to support neovascularization make it a promising option in cases where active inflammation or devitalized tissue is present. Larger studies are warranted to further define its role in facial and periocular reconstructive surgery.