title: Single-stage soft tissue reconstruction and orbital fracture repair for complex facial injuries.
abstract: BACKGROUND
  Orbital fractures with open periorbital wounds cause significant morbidity. Timing of debridement with fracture repair and soft tissue reconstruction is controversial. This study focuses on the efficacy of early single-stage repair in combined bony and soft tissue injuries.
  
  
  METHODS
  Retrospective review. Twenty-three patients with combined open soft tissue wounds and orbital fractures were studied for single-stage orbital reconstruction and periorbital soft tissue repair. Inclusion criteria were open soft tissue wounds with clinical and radiographic evidence of orbital fractures and repair performed within 48 h after injury. Surgical complications and reconstructive outcomes were assessed over 6 months.
  
  
  RESULTS
  The main outcome measures were enophthalmos, pre- and post-CT imaging of orbits, scar evaluation, presence of diplopia, and eyelid position. Enophthalmos was corrected in 16/19 cases and improved in 3/19 cases. 3D reconstruction of CT images showed markedly improved orbital alignment with objective measurements of the optic foramen to cornea distance (mm) in reconstructed orbits relative to intact orbits of 0.66, 95% confidence interval [CI] (lower 0.33, upper 0.99) mm. The mean baseline of Stony Brook Scar Evaluation Scale was 0.6, 95%CI (0.30-0.92), and for 6 months, the mean score was 3.4, 95%CI (3.05-3.73). Residual diplopia in secondary gazes was present in two patients; one patient had ectropion. Complications included one case of local wound infection.
  
  
  CONCLUSIONS
  An early single-stage repair of combined soft tissue and orbital fractures yields satisfactory functional and aesthetic outcomes. Complications are low and likely related to trauma severity.
authors.affiliation: Department of Ophthalmology, The Second Hospital of Dalian Medical University, Dalian, Liaoning Province, China.
authors.forename: Peng Sen
authors.initials: PS
authors.lastname: Wu
authors.affiliation: Department of Ophthalmology, The Second Hospital of Dalian Medical University, Dalian, Liaoning Province, China.
authors.forename: Reshvin
authors.initials: R
authors.lastname: Matoo
authors.affiliation: Department of Ophthalmology, The Second Hospital of Dalian Medical University, Dalian, Liaoning Province, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Sun
authors.affiliation: Department of Ophthalmology, The Second Hospital of Dalian Medical University, Dalian, Liaoning Province, China.
authors.forename: Li Yuan
authors.initials: LY
authors.lastname: Song
authors.affiliation: Division of Ophthalmic Plastic and Reconstructive Surgery, Department of Ophthalmology, Shiley Eye Institute, UCSD, La Jolla, CA, USA.
authors.forename: Don O
authors.initials: DO
authors.lastname: Kikkawa
authors.affiliation: Department of Ophthalmology, The Second Hospital of Dalian Medical University, Dalian, Liaoning Province, China. Electronic address: drluweicn@163.com.
authors.forename: Wei
authors.initials: W
authors.lastname: Lu
mesh_terms: D000328:Adult; D005151:Facial Injuries / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009104:Multiple Trauma; D009917:Orbital Fractures / Q000175:diagnosis / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Open orbital fractures; Orbital reconstruction; Stony Brook Scar Evaluation Scale