The purpose of this case series is to report the indications for dermis-fat grafting and the outcome of treatment in orbital soft tissue contraction among patients in a tertiary center. It is a retrospective, consecutive, interventional case series where all patients with orbital soft tissue contraction who had dermis-fat grafting were studied. All nine patients in our series underwent secondary dermis-fat grafting for orbital soft tissue reconstruction. The major cause for contracted socket was surgical eye removal following trauma. Eight of nine patients had no orbital implants inserted at the time of primary eye removal and eight patients have had failed orbital reconstructive procedures. Satisfactory cosmetic results were reported in all patients post-operatively. Dermis-fat grafting for contracted socket reconstruction was found to give satisfactory cosmetic results in our studied population.
Surgical eye removal procedures can result in orbital tissue shrinkage and shallow fornices with difficulty in prosthesis insertion and resultant unacceptable cosmetic appearance, thus, necessitating socket reconstruction [
A retrospective, interventional, non-randomized case series of all patients managed at a single tertiary center, the University College Hospital, Ibadan, Nigeria, between October 2008 and September 2018 was carried out. All patients were operated by a single surgeon. The medical records of the patients were reviewed to retrieve information on the patients’ socio-demographics, previous socket reconstructions, post-operative appearance and subjective satisfaction with the outcome of the procedure.
The procedures were performed under general anesthesia or local anesthesia (peribulbar block using 2% lidocaine with 1:100,000 adrenaline and 0.5% bupivacaine mixture). The socket was prepared for the dermis-fat graft by incising the conjunctiva, and dissecting it into the fornices, following which measurement of the defect was done (
in layers using 4-0 vicryl and 4-0 prolene sutures. The harvested graft was partly and appropriately defatted with scissors, placed into the socket with the dermis layer anteriorly oriented and sutured to the conjunctival edge with interrupted 6-0 vicryl suture. A plastic conformer was placed into the socket, temporary tarsorrhaphy was applied, and a light dressing of the eye was done after instilling chloramphenicol ointment. Consent was obtained from the patients and approval for the study was obtained from the Institutional Ethics Committee and the study conformed to the tenets of the Declaration of Helsinki.
Nine patients, (M:F, 1:2), average age, 18.4 years (range, 1 year 8 months to 57 years) had dermis-fat grafting during the study period. Two patients were less than 2 years of age (1 year 8 months and 1 year 10 months) while two patients were over 50 years (56 years and 57 years). The demographic data are shown in the Table. Eight of nine patients have had previously failed reconstructive surgeries for contracted socket prior to the dermis-fat grafting which included oral mucosal grafting (4 patients), fornix formation suture (2 patients), and transposition flap (1 patient), while details of the procedures were not clear in one patient. All patients presented with difficulty in inserting their prosthesis due to contracted socket. The indication for the surgical removal of the eye was trauma in six cases, while three children (less than 5 years of age) had congenital buphthalmos or congenital anophthamos. These indications are shown in the
Dermis-fat grafting is one of the surgical treatment options for anophthalmic socket reconstruction and can be used in primary procedure following surgical removal of the eye or secondarily, following extrusion or migration of existing orbital implant [
Primary dermis-fat grafting had been reported in previous studies [
Gender | Age | Cause of anophthalmia | Previous reconstruction/primary implant placement | Anesthesia | Outcome/further procedure | |
---|---|---|---|---|---|---|
1 | Female | 13 years | Evisceration post trauma | Nil. No implant | GA | Satisfactory. Lateral tarsorrhaphy |
2 | Male | 36 years | Enucleation post blast injury | Oral mucosal graft. No implant | GA | Satisfactory |
3 | Female | 1 year 10 months | Enucleation for congenital buphthalmos | Oral mucosal graft. No implant | GA | Satisfactory |
4 | Female | 26 years | Enucleation post gunshot injury | Transposition flap. No implant | GA | Satisfactory. Lateral tarsorrhaphy |
5 | Female | 4 years | Enucleation for congenital anophthalmos with orbital cyst | Oral mucosal graft. Had an implant | GA | Satisfactory |
6 | Male | 57 years | Evisceration for disfigured eyeball post fist injury | Fornix formation suture. No implant | GA | Satisfactory |
7 | Female | 1 year 8 months | Enucleation for congenital anophthalmia | Not known. No implant | GA | Satisfactory |
8 | Female | 42 years | Evisceration for painful blind eye post trauma | Oral mucosal graft. No implant | LA | Satisfactory |
9 | Male | 56 years | Evisceration post trauma | Fornix formation suture. No implant | GA | Satisfactory |
GA = General anesthesia, LA = local anesthesia.
Dermis-fat grafting can be performed in all age groups including children and, two of our patients are less than 2 years of age. Dermis-fat graft serves as an ideal, dynamic orbital implant with its biocompatibility and ability to grow over time thus stimulating orbital growth [
Complications of dermis-fat grafting are quite common, although often minor and include graft necrosis and atrophy, granuloma formation, graft hirsutism, socket keratinization, wound dehiscence, and hematoma of the donor site [
In conclusion, the major indication for dermis-fat grafting in our region is contracted socket following surgical removal of the eye as a result of trauma. Primary orbital implants were not inserted at time of surgery in these patients. Dermis-fat grafting gives satisfactory cosmetic results with minimal complications in our patients.
The author declares no conflicts of interest regarding the publication of this paper.
Fasina, O. (2019) Dermis-Fat Graft for Contracted Socket Reconstruction in an Indigenous Black Population, Southwestern Nigeria. Case Reports in Clinical Medicine, 8, 87-92. https://doi.org/10.4236/crcm.2019.84010