Reconstruction of the Orbit and Anophthalmic Socket Using the Dermis Fat Graft: A Major Review

Abstract

Purpose: To perform a comprehensive review of dermis fat graft (DFG) in socket reconstruction and illustrate the technical nuances and outcomes using a retrospective case review. Methods: A literature search of 143 texts was reviewed. A retrospective case series of 34 patients following primary or secondary DFG after enucleation at a single institution (2009–2019) was performed. Clinical outcomes were statistically analyzed. Variables investigated included age, sex, race, surgical indication, muscle reattachment, complications, motility, eyelid position, prosthesis fit, and need for additional surgery. Results: The history of DFG, use in socket reconstruction, primary and secondary indications, and surgical techniques are described. Thirty-two adults and 2 pediatric cases of DFG were reviewed; 18.75% indications were primary and 81.25% were secondary. Good eyelid position was observed in 83.3% of patients with primary DFG versus 37.5% with secondary DFG (p = 0.07). Postoperative complications occurred in 58.8% of patients, were typically mild, and resolved with minimal or no intervention. No statistically significant differences were found between occurrence of any particular complication in primary versus secondary DFG placement (p = 0.36) or between primary and secondary DFG placement and the need for additional surgery (p = 1.0). Among the 67.7% patients who had implant exposure or extrusion as an indication for DFG, 39.1% required additional surgery within 2 years. Advanced age was not associated with higher complication rates (p = 0.12). Conclusions: DFG is an excellent option for socket reconstruction, particularly in cases involving pediatric patients, complicated orbits, history of multiple previous surgeries, and inflamed, contracted, or scarred sockets.

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

“…Diab and Alahmadawy Clinical bare area. 4 Additionally, it has been assumed that the use of scleral ring rather than solid conformer helps avoid direct pressure on the dermis face which would impede both vascularization and conjunctivalization. 15,16 Following DFG implantation, the persistence of white color for more than 2-3 weeks indicates poor healing 14 that matched perfectly with the sequence of events of delayed healing in this study; persistent white dermis followed by superficial dermal ulcer that ended up by a full thickness ulcer with exposure of underlying fat.…”

“…Various surgical methods have been described on epidermis removal during DFG preparation, but there is no current consensus on the optimal one. 1,4,6,7 In this study, we aimed to compare the outcomes of low power setting electrocoagulation for epidermis removal, commonly employed in our institutes with no robust evidence to support its use, performed in a consecutive series of patients during the year 2018 versus the conventional free hand scalpel dissection performed in a previous series of patients during the year 2017 and to study the impact of both techniques on GFG take. This sequential grouping explains the significantly longer duration of follow up in group A.…”

“…Since its resurrection by Smith and Petrelli in 1978, 1 dermis-fat grafting (DFG) has been proved to be effective in anophthalmic socket reconstruction as either a primary or a secondary implant. [2][3][4] It augments both volume and surface of the anophthalmic socket while avoiding the disadvantages of allogenic orbital implants. The fat component of these composite grafts restores the orbital volume, while the dermis acts as a scaffold for surface epithelialization and provides a rigid substratum to which the conjunctiva and extraocular muscles can be sutured.…”

“…Besides, the dermis has been assumed to enhance graft vascularization which makes it less vulnerable to reabsorption. 4 The complete removal of the epidermis layer is a critical step to avoid postoperative complications such as hair growth, keratinization, formation of epidermoid cysts and mucoid discharge. 5,6 Various surgical methods have been described for epidermis removal including surgical blade dissection, dermatome, dermabrasion device, and diamond burr.…”

“…5,6 Various surgical methods have been described for epidermis removal including surgical blade dissection, dermatome, dermabrasion device, and diamond burr. 1,4,6,7 The scalpel dissection allows even surgical plane between epidermis and dermis with uniform removal of the epidermis; however, it is a slightly lengthy step with the possibility of leaving residual epidermal appendages. 7 Trying to avoid the drawbacks of scalpel dissection, some researchers prefer to use a power drill with a diamond burr or an air-driven dermabrader.…”