Periumbilical fat auto-graft associated to a porous orbital implant for socket reconstruction after enucleation.
Having to remove the sclera, fat and the optic nerve in patients undergoing an enucleation, translates in a larger volume that needs to be replaced to achieve good motility and aesthetic results. Using a 20 or 22 mm implant can only partially replace the removed volume. We report the results of our enucleation technique, which includes the use of a porous orbital implant combined with a primary fat graft to replace a higher percentage of the removed volume to achieve a better cosmetic outcome and to avoid implant related complications in high risk patients. Prospective, non-randomized study of enucleated patients for whom porous orbital implantation was performed with anterior placement of a fat auto-graft. The development of implant extrusion or exposure was recorded as well as the presence of conjunctival wound dehiscence and infection. Orbital volume was clinically and radiologically evaluated as well. Twenty-eight patients were included, with a postop follow-up of at least 6 months (6-79 months). No cases of migration or extrusion were found. One case of a large exposure resolved completely. All MRI demonstrated proper implant-graft integration and vascularisation. The aesthetic result and the symmetry were very adequate, with Hertel differences of less than 2 mm in all cases and good motility range. The fat graft is well tolerated, showing low incidence of implant-related complications whilst maintaining good volume and motility.
a Ophthalmic Plastic Surgery Department , Instituto de Microcirugia Ocular , Barcelona , Spain.|b Ophthalmology Department , Hospital Universitari Vall D´Hebron , Barcelona , Spain.
Ramon
R
Medel
b Ophthalmology Department , Hospital Universitari Vall D´Hebron , Barcelona , Spain.
Tirso
T
Alonso
c Centro Protesico Ocular , Multiopticas Florit, Diputació , Barcelona , Spain.
Francisco
F
Pelaez
a Ophthalmic Plastic Surgery Department , Instituto de Microcirugia Ocular , Barcelona , Spain.
LuzMaria
L
Vasquez
D000273:Adipose Tissue / Q000637:transplantation*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015353:Eye Enucleation / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009915:Orbit / Q000000981:diagnostic imaging / Q000601:surgery*; D020273:Orbital Implants; D016062:Porosity; D011446:Prospective Studies; D019919:Prosthesis Implantation; D019651:Plastic Surgery Procedures; D014182:Transplantation, Autologous; D014472:Umbilicus / Q000637:transplantation*
Enucleation; anopthalmic socket; fat auto-graft; orbital impland