Nylon foil "wraparound" repair of combined orbital floor and medial wall fractures.
OBJECTIVE
To evaluate a technique of implanting a single 0.4-mm-thick nylon foil (Supramid) continuously across combined medial wall and floor fractures within weeks of orbital trauma.


METHODS
This retrospective, interventional case series includes patients with combined medial wall and floor fractures with or without external orbital and facial fractures, without prior surgery, and who were in the early posttrauma phase. One hundred two orbits in 98 consecutive patients were treated with a "wraparound" technique. The surgical technique is provided in detail. Comatose patients, those with cranial nerve palsies, severe globe injury, anophthalmia, or previous repair of the same fractures were excluded. Patients underwent surgery from 5 to 21 days after trauma. Postoperatively (average, 6.2 months), patients were evaluated for enophthalmos, extraocular motility, and diplopia.


RESULTS
In 101 of 102 orbits, normal globe position, and full extraocular motility without diplopia was accomplished. One orbit had persistent enophthalmos, requiring a second procedure. This same patient had ipsilateral restriction in extreme upgaze, but no diplopia symptoms. This orbit had complete loss of inferomedial strut support. Overall, strut loss was not a risk factor for subsequent enophthalmos. No other patient had globe malposition, restrictive myopathy, or diplopia. Implant migration, hemorrhage, fistula, or infection was not observed. The transconjunctival and canthal wounds were hidden and tolerated by all patients with no eyelid cicatrization, webbing, or malposition.


CONCLUSIONS
The "wraparound" technique for 0.4-mm nylon foil implantation continuously across orbital floor and medial wall fractures was associated with almost no enophthalmos and diplopia in this series.
Nunery
William R
WR
Oculofacial Plastic and Orbital Surgery, Indianapolis, Indiana, USA. mathieu113@hotmail.com
Tao
Jeremiah P
JP
Johl
Sukhjit
S
D004172:Diplopia / Q000517:prevention & control; D015841:Enophthalmos / Q000517:prevention & control; D005133:Eye Movements; D005592:Fracture Fixation / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D009757:Nylons; D013508:Ophthalmologic Surgical Procedures; D009915:Orbit / Q000000981:diagnostic imaging / Q000293:injuries*; D009917:Orbital Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D020273:Orbital Implants; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
D009757:Nylons; C009930:polyamide mesh