The use of autologous dermis grafts for the reconstruction of the anophthalmic socket

Correction of orbital implant exposure using a supra-brow island flap pedicled with orbicularis oculi muscle

PURPOSE

To describe our experience of the supra-brow island flap pedicled with orbicularis oculi muscle technique for correcting orbit implant exposure.

MATERIALS AND METHODS

This retrospective study reviewed 32 patients that underwent orbit implant exposure surgery using a supra-brow island flap pedicled with orbicularis oculi muscle. All data were reviewed from patients in Eye & ENT Hospital of Fudan University, Shanghai during January 2018 to July 2020. The patient demographics, the original etiology, surgical procedures, implant types, and follow-up interval were recorded. The primary outcome was the long-term coverage of the supra-brow island flap pedicled with orbicularis oculi muscle, and the post-surgical complications and management were secondary outcomes.

RESULTS

28 eyes of 28 patients had functional results and satisfactory cosmetic outcomes at final follow up(range, 9-29 months). Among the other 4 patients, the recurrence of exposure was recorded during the follow-up, two of these patients successfully underwent dermis fat grafts(DFGs), one recovered after conservative treatment, and one refused treatment.

CONCLUSIONS

The supra-brow island flap pedicled with orbicularis oculi muscle is a technique available to manage orbital implant exposure when other simpler and more direct techniques have been tried and failed.

PRECIS

A new flap for orbital implant exposure.

Primary Dermis Fat Grafting for Socket Reconstruction: Retrospective Comparison of Electrocoagulation versus Scalpel Dissection for Epidermis Removal

Purpose

To evaluate outcomes of the use of electrocoagulation for epidermis removal in dermis fat grafting (DFG) compared to the conventional scalpel dissection in patients who underwent primary anophthalmic socket reconstruction.

Design

Retrospective, observational, and comparative study.

Methods

A retrospective review was performed on patients who underwent primary DFG for socket reconstruction between 2017 and 2019 at tertiary teaching hospitals. Patients with previous orbital surgery, previous radiotherapy to the periocular region, any medical condition that affects healing, cicatrizing ocular surface disease or heavy smokers were excluded. Patients with complete documentation of preoperative and postoperative data only were included. Patients were divided into two groups; group A: epidermis removal by the traditional scalpel dissection and group B: epidermis removal using low power setting electrocoagulation. The main outcome was the timing of complete epithelialization of the dermis layer. Other outcomes included implant motility, prosthesis fitting, patient’s satisfaction, and any complications.

Results

A total of 27 patients met the study criteria, and the mean follow-up period was 24.81 months. There were no differences between both groups regarding preoperative characteristics. The mean duration of complete epithelialization of the DFG implant was 9.15 ± 2.94 weeks in group A compared to 22.29 ± 4.43 weeks in group B (p value <0.001). Dermal ulceration was noticed in 9 patients (64.3%) in group B compared to none in group A (p value =0.001). Dermal ulceration was significantly associated with long conjunctival healing period (p value <0.001). Volume loss was more common in group B while graft hirsutism and granuloma were more evident in group A. Final prosthesis fitting was possible in all included patients.

Conclusion

Epidermis removal using the electrocoagulation is related to much more delayed epithelialization of the dermis with a higher rate of dermal ulceration compared to the scalpel dissection technique. However, there was no significant difference between both groups regarding the final prosthesis fitting or the overall patient satisfaction.

Tungiasis infestation of dermis fat graft in an anophthalmic socket

A patient with an anophthalmic socket with a dermis-fat graft (DFG) developed inflammation and a foul odour in the right socket. The DFG was surgically removed and Tungiasis infestation was detected. This is the first case to report Tungiasis infestation in a DFG in an anophthalmic socket.

Repair of orbital implant exposure using Müller's muscle flap

INTRODUCTION

The purpose of this study is to analyse the 2-stage Müller's muscle flap technique for the treatment of orbital implant exposure and its results.

MATERIALS AND METHODS

This retrospective study reviewed all patients undergoing surgery using this technique in our university hospital over a 14-year period (1999-2012) in terms of success (no re-exposure of the implant) or failure.

RESULTS

Nineteen patients were managed using this 2-stage procedure. Orbital implant exposure occurred 94.4 months (2-240) after implantation. The success rate was 68.4% (13/19) and failure rate 31.6% (6/19). Risk factors for exposure were enucleation for melanoma followed by radiation therapy, acrylic implant, and early exposure probably due to excessive suture tension.

DISCUSSION

Implant exposure is the most common complication after evisceration, enucleation or socket surgery. Several techniques to repair exposures have been described. Two-stage Müller's muscle flap is an interesting option, especially for patients presenting defects larger than 4mm(2) and without previous radiation therapy treatment.

CONCLUSION

The two-stage Müller's muscle flap procedure allows for an autologous vascularized pedicle flap from the ipsilateral upper eyelid. It is a reliable technique with a success rate of 68% in our study.