A two-layer closure of sino-orbital fistula.
A two-layer closure of sino-orbital fistulae using tension-free local flaps is described. For small fistulae, the opening is first closed with a mucosal turnover flap; this is combined on the orbital surface with a local rotational advancement flap of the orbital skin. For larger fistulae where a mucosal turnover flap cannot be fashioned, a two-stage, delayed, composite mucocutaneous rotational flap is used. The advantages of these techniques are: (1) a mucous membrane to provide nasal or sinus lining, insulating the raw ventral surface of the skin flap; (2) each flap has an independent blood supply; (3) local flaps are used, avoiding the use of a pedicle flap from forehead; (4) excellent cosmesis since tissues outside the orbital rim are not disturbed; and (5) does not require refitting of exenteration prosthesis since the integrity of the orbital rim is maintained. The authors have used these techniques in six patients with chronic sino-orbital fistulae of the exenterated socket. In one patient, a wound dehiscence occurred and a small fistula measuring 3 to 4 mm in diameter persisted. The fistulae of the remaining five patients were successfully closed.
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Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine 33101.
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D000328:Adult; D000368:Aged; D005069:Evaluation Studies as Topic; D005260:Female; D005402:Fistula / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009916:Orbital Diseases / Q000601:surgery*; D010254:Paranasal Sinus Diseases / Q000601:surgery*; D013524:Surgical Flaps; D013536:Suture Techniques