Dermis-fat Graft Research Articles

Association between Frequency of Prosthesis Cleaning and the Discharge Characteristics and the Tear Film in Subjects with Anophthalmic Socket after Eviceration with Dermis Fat Graft

AIM:To analyze the associations between frequency of prosthesis cleaning with the discharge characteristics and the tear film in subjects with anophthalmic socket post evisceration with dermis fat graft.SUBJECTS AND METHODS:This study is an analytic observational with cross sectional design study with control. The subjects of the study were unilateral acquired anophthalmic socket after evisceration with dermis fat graft at University of Sumatera Utara General Hospital which amounts to 30 subjects or 60 eyes (30 unilateral anophthalmic sockets, 30 contralateral eyes). Data was obtained from April 2018 to May 2018.RESULT:There is significant association between frequency of prosthesis cleaning and the frequency of discharge (P = 0.001) and tear film quantity (P = 0.024). There is also significant association between the tear film quantity and the frequency of discharge (P = 0.024).CONCLUSION:There was a significant association between frequency of prosthesis cleaning with the frequency of discharge and the tear film in subjects with Acquired Unilateral anophthalmic socket post-evisceration with dermis fat graft.

Corrective Strategies for a Complex Deformity Caused by "European-Style Double Eyelid" Blepharoplasty in Asians.

"European-style double eyelid" blepharoplasty often leads to a complex deformity, which includes one or more of the following features: a high fold, upper eyelid depression, multiple folds, an obvious scar, blepharoptosis, and lower flap tumidness. However, there is still a lack of comprehensive research on evaluation and treatment strategies for this complex deformity. During a 6-year period, 65 patients (106 eyes) with a high fold and upper eyelid depression underwent corrective blepharoplasty. The authors classified this complex deformity as mild, moderate, or severe based on the extent of adhesion and tissue insufficiency, and we performed preaponeurotic fat flap transfer in 47 eyes (44.3%), free fat graft in 35 eyes (33%), and free dermis-fat graft in 24 eyes (22.6%), respectively. The outcomes in 87 eyelids were judged as excellent; and the grading was excellent in 41 eyes (87.2%) that underwent preaponeurotic fat flap transfer, 30 eyes (85.7%) that received a free fat graft, and 16 eyes (66.7%) that received a free dermis-fat graft. The outcomes in only 3 eyes (2.8%) were evaluated as unsatisfactory. The fundamental reasons behind this deformity were adhesion and tissue insufficiency above the supratarsal crease. The purpose of correction was to reconstruct the gliding system and restore the volume. The authors performed preaponeurotic fat flap transfer, free fat graft, and free dermis-fat graft and achieved satisfactory results. Great improvement in ptosis was achieved by releasing the adhesion and lowering the fold in patients with normal levator muscle function. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Assessment of outcomes and complications of posterior pharyngeal wall augmentation with dermal fat graft in patients with Velopharyngeal Insufficiency (VPI) after primary cleft palate repair: A pilot study

IntroductionMaterials used for posterior pharyngeal wall augmentation have been associated with important complications (exogenous materials) or variable and unpredictable durability (exogenous and endogenous materials); therefore, introducing a different material for augmenting the posterior pharyngeal wall seems necessary for reviving this relatively forgotten technique.The purpose of this study was to emphasize on the use of a material associated with minimal complications and maximum recovery and durability in correcting VPI and the use of evaluative adjuncts such as nasoendoscopy and videofluoroscopy to assess surgical outcomes. MethodsIn a pilot study, 24 patients underwent posterior pharyngeal wall augmentation with dermal fat graft harvested from the low crease abdominal region. Early and late complications, autologous graft durability in posterior pharynx, and speech improvement were assessed. ResultsThere was a significant improvement in hypernasality, nasal emission, and nasal grimace after posterior pharyngeal wall augmentation with dermal fat graft (p<0.0001). The authors observed no significant life-threatening complication. The most evident short-term complication was snoring, which occurred in five patients, and all relieved uneventfully. ConclusionThe authors believe that augmenting the posterior pharyngeal wall with dermal fat graft is effective in improving hypernasality in patients with moderate velopharyngeal gap size and relatively adequate velar motion. This method has minimal complication profile because of autologous tissue application.

Platelet-rich plasma to rescue an ulcerated orbital dermal fat graft.

Central graft ulceration is a rare complication of an orbital dermal fat graft caused by diminished blood supply to the implant. This study reports on the efficacy and safety of the use of a single subconjunctival injection of autologous platelet-rich plasma to rescue an ulcerated orbital dermal fat graft. Three patients, who had undergone autologous dermal fat graft to treat their anophthalmic socket, were given a 2-mL subconjunctival platelet-rich plasma injection in the exposed graft margins. Demographic and clinical features, treatment protocol, clinical course, complications and follow-up time are reported. In the preoperative examination, all the patients presented a primary epithelial defect of the dermal fat graft. There were no major complications such as necrosis or infection. One patient presented a small conjunctival granuloma at 1-month follow up. Mean postoperative follow-up duration was 13 (range: 10-16) months. By 1 month, the chronic epithelial defect had resolved with the graft integrated within the orbital tissues in all cases. All patients were referred for artificial prosthesis placement. Although further work is needed, our findings suggest that a single subconjunctival platelet-rich plasma injection could be an effective, safe and economic alternative to surgery to rescue an ulcerated orbital dermal fat graft.

A surgical approach to linear scleroderma using Medpor and dermal fat graft.

Linear scleroderma en coup de sabre (LScs) is a variant of localized scleroderma. This disease typically occurs in patients in their 20s or younger individuals and predominantly occurs in the forehead area. A 26-year-old man with linear scleroderma was surgically treated at our center with Medpor (porous polyethylene) and dermal fat graft for the forehead lesion. After 26 months of postoperative follow-up, the depressed lesion that appeared scarred as well as the margins improved significantly. The surgical treatment of LScs using Medpor and dermal fat graft is an effective treatment modality that can increase patient satisfaction.

Characteristics and management of congenital anophthalmos and microphthalmos at a tertiary eye hospital

ABSTRACTPurpose: The purpose of the study is to evaluate demographic data and outcomes of the management of congenital anophthalmia/microphthalmia.Methods: This retrospective, descriptive, cross-sectional study evaluated patients with congenital anophthalmia/microphthalmia managed from 2004 to 2014 at a tertiary hospital in Saudi Arabia. Data were collected on patient age, gender, cause, orbital status, laterality, systemic comorbidities, ocular evaluation, and management (type of surgery, type of orbital implant, and complications). The main outcome measure was the ability to hold the prosthesis.Results: The study sample was composed of 513 eyes/sockets of 365 patients. Two-hundred and seventeen (59.4%) patients were unilateral cases. Forty-one (8%) sockets were due to congenital anophthalmia and 471 (92%) were due to microphthalmia. There were 73.2% isolated cases and 28.5% with systemic involvement. Systemic involvement was more common in bilateral cases. The most commonly associated conditions were central nervous disorders. One-hundred and nineteen (46.7%) cases had parental consanguinity. Two hundred and eighteen eyes/sockets (163 patients) underwent surgery including conjunctival flap (38; 17.4%), evisceration (38; 17.4%), enucleation (16; 7.3%), or procedures to improve the anophthalmic socket volume (45; 20.6%). Volume enhancing procedures included polymethylmethacrylate orbital implants (26; 57.8%), expanders (11; 24.4%), integrated hydroxyapatite or polyethylene implants (2; 4.4%), and dermis-fat graft (6; 13.3%). In most cases, clinical or surgical management resulted in a successful outcome.Conclusion: Anophthalmia/Microphthalmia was detected in 36.5 patients/year. The majority had isolated microphthalmia. Good outcomes were achieved with clinical or surgical management in the majority of cases.

Orbital Fat Injection: Technique and 5-Year Follow-Up.

Orbital volume loss, early or late, is common after placement of an orbital implant or dermis fat graft, and there is currently no satisfactory long-lasting solution. Hyaluronic fillers are relatively easy to administer but are prone to migration and are temporary. Cannula-based orbital fat grafting has not gained the status of standard of care because of perceived low likelihood of success in the near term. This paper describes a technique for fat volume augmentation, its rationale, long-term follow-up, and a description of a complication unique to fat grafting in the orbit. Ten consecutive subjects with acquired anophthalmic enophthalmos were enrolled in two IRB (institutional review board)-approved protocols (10.27 and 12.01) undergoing a single session of autologous fat grafting to the orbit using a closed blunt cannula technique. Preoperative photography and non-contrast MRIs (magnetic resonance imaging) were obtained prior, immediately after, and at 1year after injection. Yearly postoperative photography was performed on subjects with successful results. Three of five subjects in IRB 10.27 clearly showed a clinically apparent increase in orbital volume at 1year. One subject who failed to show improvement also sustained inadvertent injection into three extraocular muscles; she subsequently volunteered to enter IRB 12.01. Three of five subjects in IRB 12.01 did benefit, showing volume increase at 1year, including the subject who had experienced intramuscular injection in 10.27. One subject in IRB 12.01 was lost to follow-up. Of the total of ten subjects enrolled, three showed no improvement and one was lost to follow-up; six subjects showed volume improvement at 1 year with two retaining the correction at 5 years and four showing variable diminution over 2-5 years. With the exception of the subject who sustained injection into extraocular muscles, none experienced complications. A modified technique is recommended for orbital fat injection distinct from methods used elsewhere in the body. Theoretical limits of volumetric enhancement temper expectations in orbital fat grafting and should inform surgical planning. Cannula-based orbital fat grafting can be done safely and result in a gain of orbital fat volume at 1year and in some cases up to 5years. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Glabellar Rejuvenation in Forehead Lift: Reversed Periosteum or Dermal Fat Graft to Cover Pedicled Glabellar Flap.

Forehead aging is characterized by wrinkles, loss of skin elasticity, brow ptosis, and soft-tissue atrophy. For patients with prominent rhytids and marked brow ptosis, forehead lift is still the most effective treatment with a persisting result. In order to eliminate the glabellar wrinkles, forehead lift usually requires the removal of the corrugator supercilii muscle and procerus, which can lead to glabellar flattening or depression. Instead of muscle removal, the corrugator supercilii muscle, procerus, and the underlying galea were dissected as a pedicled glabellar flap. Then reversed periosteum or dermal fat graft was used to cover the glabellar flap to restore the glabellar volume. From January 2005 to November 2014, a total of 164 coronal and 42 trichophytic forehead lifts were performed. Reversed periosteum was used to cover the glabellar flap in 191 patients while dermal fat graft was applied in 15 patients with a follow-up period ranging from 6 months to 10 years. There was no irregularity or depression in the glabellar region in the group of reversed periosteal flap. The take of dermal fat graft placed over the glabellar flap was minimal. Complications from surgical procedures occurred in 2.91% of the patients. There was 1 asymmetry, 4 patients with higher than desired frontal hairline for implantation of autologous follicular units, and 1 patient with scar hyperplasia. There was no hematoma or nerve injury, no permanent numbness, and no alopecia. The techniques are simple and effective to eliminate the glabellar wrinkles and maintain or restore the glabellar volume.

Fat necrosis after breast-conserving oncoplastic surgery.

Fat necrosis is a subjective early as well as delayed complication, which sometimes mimics local recurrence and ruins the quality of life by pain and poor cosmetic result. While, the frequency and severity of fat necrosis are important issues that breast surgeons should explain to the patient, these data are not revealed well. A total of 1476 patients who underwent breast surgery from January 2000 to December 2012 were enrolled in the present study. We assessed fat necrosis by mammographic and physical findings and created grading criteria: Grade (G) 0, no fat necrosis; G1, no symptomatic fat necrosis (mammographic dystrophic calcification); G2, mild symptomatic necrosis (mammographic dystrophic necrosis with tumor); G3, severe symptomatic necrosis (mammographic dystrophic necrosis with pain or skin change); and G4, symptomatic necrosis requiring surgical intervention. Of the 1476 patients enrolled, 393 (27%) underwent mastectomy, and 1083 (73%) underwent breast-conserving surgery. We achieved a high rate of breast-conserving surgery at a total rate of 73% over the study period and maximum rate of 88% in 2010, using oncoplastic procedures. We mainly adopted a pedicled fat flap (417/1083; 39%) and a free dermal fat flap (40/1083; 3.7%). Among the 626 patients who underwent partial resection with no replacement for the defect, G1-G2 fat necrosis was seen in 29/626 (4.6%). While, the incidence of fat necrosis with pedicled fat flap and free dermal fat graft was 68/417 (16%) and 40/40 (100%), respectively, showing a significant difference (p < 0.01). Furthermore, the incidence of G3-G4 fat necrosis was significantly higher with free dermal fat grafts (25%; 10/40) than with pedicled flap (2.9%; 12/417) (p < 0.01). Among pedicled flaps, the incidence of fat necrosis with inframammary adipofascial flaps was 56% (14/25) which was higher than that with lateral epidermal fat flaps (12%; 33/276) (p < 0.01), and rotation of surrounding breast tissues (8%; 21/116) (p < 0.01). The incidence of G3 fat necrosis was also high at 20% (5/25) in inframammary adipofascial flaps. Breast-conserving oncoplastic surgery carries a risk of fat necrosis as a delayed complication. The incidence rate and severity of fat necrosis with each procedure should be assessed. We should select fat grafts with a good blood supply to replace defects of breast-conserving therapy.

Hard palate-dermis fat composite graft for reconstruction of contracted anophthalmic socket

ABSTRACT Purpose: To describe a novel technique of using a hard palate-dermis fat composite graft (HPDFG) for reconstruction of a contracted anophthalmic socket. Methods: Retrospective, noncomparative, interventional case series of four patients who underwent HPDFG placement by one surgeon between 2010 and 2017. Results: Six harvested HPDFGs were placed in four patients with contracted anophthalmic sockets. A harvested hard palate graft (HPG) and a dermis fat graft (DFG) were adjoined with sutures to form a composite graft. All adhesions and symblephara between the eyelid and the anterior surface of the anophthalmic socket were lysed. The HPG component was attached to the tarsal margin to vertically lengthen the eyelid. The free edge of the DFG was sutured to the cut edge of the bulbar conjunctiva to simultaneously expand the anterior conjunctival surface area and fornix volume. The line of union between the two grafts formed the apex of the new fornix. Four HPDFG were used to reconstruct both the upper and lower lid fornices in two severely contracted sockets. Three patients received post-operative 5-fluorouracil (5-FU) injections. Three patients underwent additional revisions with buccal mucous membrane graft, amniotic membrane graft, full-thickness skin graft, pedicle flap, and dermal fillers. All four patients achieved excellent cosmesis and comfortable prosthesis fit. Conclusions: Composite HPDFG is an effective method of reconstructing a contracted anophthalmic socket by restoring volume, lengthening the posterior lamella, and expanding the fornix to allow for successful prosthesis retention. Adjunctive use of 5-FU injections can delay post-operative cicatrization.

Autologous dermis-fat grafts in head and neck patients: Indications and evaluation in reconstructive surgery

PurposeThe aim of this study was to examine the indications and results of autologous dermis-fat grafts in the reconstruction of maxillofacial soft-tissue defects. Materials and methodsA total of 93 patients with dermis-fat graft reconstruction due to a soft tissue defect in the head and neck region were enrolled in this retrospective clinical study between March 2002 and January 2017. They were classified into the subgroups ‘parotid surgery’, ‘orbital surgery’, and ‘facial surgery’. All the patients were evaluated for wound complications, and the general indications were discussed. ResultsIn all, 96 dermis-fat grafts were performed in 93 patients. A total of 34 complications that arose in 30 patients were assessed. The dermis-fat graft was primarily transplanted in 50 cases and secondarily in 46. Of the patients, 90 showed well-integrated dermis-fat grafts. A major complication occurred in three patients. ConclusionDermis-fat grafts for the reconstruction of maxillofacial soft-tissue defects represent a reliable method with a low rate of major complications. The graft can be used as a primary as well as secondary transplant. Especially in parotid and orbital surgery, the dermis-fat graft appears to be a transplant of choice. It can also be used as an alternative in facial surgery, lip enhancement, and special individual cases.

Long-term outcomes after cosmetic customized prostheses and dermis fat graft in congenital anophthalmia: a retrospective multicentre study.

To evaluate long-term outcomes of progressively enlarging cosmetic customized prostheses (CCP) early after birth followed by dermis fat graft (DFG), as a strategy of socket rehabilitation in children with clinical congenital anophthalmia (CCA). Twenty patients with unilateral and two patients with bilateral CCA were enrolled. All patients were treated by inserting a CCP at the time of their first assessment which was then enlarged. Subsequently they underwent DFG. Differences in vertical palpebral aperture (VPA) and horizontal palpebral length (HPL), between affected and unaffected sides, were recorded at the first CCP fitting as well as before and after DFG. Satisfaction with cosmetic results, prosthetic retention, and complications rate were assessed. Magnetic resonance imaging of the orbit was performed in all patients before and after surgery. A significant decrease in the difference between the normal and the anophthalmic side of both PA and HPL was found over follow-up. Both VPA and HPL differences decreased by 47.6% (10.5 mm, range 1-28 mm) and by 7.1% (5.8 mm, range 0-18 mm), respectively. Satisfaction in terms of cosmetic outcomes proved to be very positive, being "very satisfied" for families and "satisfied" for physicians. Excellent retention of prostheses was observed in all cases. A rehabilitating strategy combining early CCP and further DFG proved to be a valuable approach in children with CCA, offering significant benefits in terms of socket expansion, prosthetic retention, psychological impact, and cosmetic outcomes.

Tungiasis infestation of dermis fat graft in an anophthalmic socket

A patient with an anophthalmic socket with a dermis-fat graft (DFG) developed inflammation and a foul odour in the right socket. The DFG was surgically removed and Tungiasis infestation was detected. This is the first case to report Tungiasis infestation in a DFG in an anophthalmic socket.

Surgical and oncological outcomes of free dermal fat graft for breast reconstruction after breast-conserving surgery.

Oncoplastic breast surgery originated in order to improve the esthetic result of breast-conserving surgery (BCS). Autologous free dermal fat graft (FDFG) is an emerging oncoplastic technique to improve the cosmetic outcome of breast-conserving surgery. The aim of this study was to analyze our experience with FDFGs in breast reconstruction after breast-conserving surgery. Oncological outcomes, surgical complications and cosmetic results were considered. This retrospective chart review study considered all consecutive oncoplastic breast treatment by means of FDFG reconstruction during the period between September 2011 and September 2012 in our Clinic of Surgery (University of Udine, Italy). The data collected included patient and tumor characteristics and outcomes (cosmetic and oncological). During the study period, 37 women were treated by breast cancer surgery and immediate breast reconstruction by FDFG. At a 3-year follow-up, we found no cases of recurrence among breast cancer patients treated by FDFG; at a 18-month follow-up, we found a prevalence of 75.0% of women extremely satisfied with their oncoplastic surgery and a high prevalence of excellent or good cosmetic outcomes (70.3%) according to objective and subjective cosmetic assessment. Immediate breast reconstruction by FDFG after BCS in a population selected for a low risk of breast cancer recurrence seems to be an oncologically safe option, with a good cosmetic outcome and a high prevalence of women satisfied with the treatment.

Augmentation of the Median Tubercle with Dermis-Fat Graft in Children with Repaired Cleft Lip.

Deficiency of the median tubercle is a common residual deformity after repair of cleft lip. The purpose of this study was to analyze the change in labial contour after insertion of a dermis-fat graft. Patients with repaired cleft lip who underwent secondary dermis-fat grafting of the median tubercle between 2012 and 2015, along with preoperative and greater than or equal to 3-month postoperative three-dimensional photographs, were included. The photographs were registered to one another and measurements made before and after grafting using anthropometric landmarks. Outcome variables included the following: labial surface area, midline labial height (ls-sto), and lateral labial height (cphi-sto'). Twenty-five patients were included: 14 with unilateral and 11 with bilateral repaired cleft lip. Mean age at graft placement was 10.9 ± 3.2 years. Preoperative and postoperative three-dimensional images were taken at 13.6 ± 21.6 weeks before and 34.8 ± 25.1 weeks after the procedure, respectively. There were significant increases in labial surface area (11.5 percent; p = 0.019) and labial height (14.1 to 18.5 percent; p = 0.002) after grafting. Augmentation was greater in bilateral clefts (25.5 percent at midline and 16.8 percent laterally) compared with unilateral clefts (11.6 percent at midline and 12.5 percent on the grafted noncleft side). Intrarater and interrater reliability was excellent for all measurements. Dermis-fat grafting significantly increases contour of the median tubercle in patients with repaired cleft lip. Therapeutic, IV.

Customized 3D printing: A novel approach to migrated orbital implant

This paper describes a novel approach to treat migrated orbital implants post socket surgery. Implant migration may hinder the final aesthetic outcome of a custom ocular prosthesis. Once an implant migrates within the orbit there tends to be fibrosis around the implant. This fibrosis does not allow for centeration of the implant during repeat surgery. Hence treatment of a migrated implant traditionally involves implant removal with dermis fat grafting. Dermis fat graft though an option, needs a second site surgery that may be unacceptable to many patients. Also the rate of graft necrosis is as high as 40%. This paper describes a technique to create a custom orbital implant that allows recenteration of the migrated implant centrally, using 3-dimension (3D) printing and rapid prototyping to construct the patients affected orbit. This orbit is used as a mould to create the custom orbital implant that aids in volume augmentation as well as recenteration of the migrated orbital implant.

Orbital implant exposure after Acanthamoeba panophthalmitis

PurposeAcanthamoeba is a protozoa that can lead to severe ocular disease and sequelae. Although intraocular Acanthamoeba infection is rare, the following case demonstrates an unusual presentation of recurrent Acanthamoeba infection in a 30 year old contact lens wearing male. ObservationsAfter presenting with recurrent Acanthamoeba keratitis and undergoing various treatments, the patient developed nodular scleritis, which evolved into panophthalmitis, and ultimately, required enucleation. Eight months post-operatively, the patient developed orbital implant exposure secondary to persistent Acanthamoeba infection and underwent removal of the implant and aggressive, systemic treatment involving a multispecialty care team. He then underwent placement of a dermis fat graft and had no signs of persistent infection at the time of last follow-up, which was 24 months after placement of the dermis fat graft. Conclusionsand Importance: To the authors' knowledge, this is the first known case of Acanthamoeba infection causing orbital implant exposure. Persistent infection should be considered in Acanthamoeba patients who have undergone enucleation and have orbital implant exposure. Better knowledge regarding the pathogenesis and extracorneal complications of this challenging disease may improve patient care and outcomes.

Dermis-fat graft for anophthalmic socket reconstruction: indications and outcomes.

To evaluate the outcomes of dermis-fat graft procedure for orbital volume replacement in anophthalmic socket. A retrospective chart review was performed studying all dermis-fat graft surgeries done at King Khlaed Eye Specialist Hospital in the last 10-year period. Sixty-two anophthalmic socket carriers underwent dermis-fat graft during the study period. Data were collected on characteristics of the patients, postoperative complications, cosmesis, and functional results such as the ability to hold an external prosthesis. Mean age of the patients included in the study was 34.2 ± 9.7 years. There were 38.7% of patients with grade 3 anophthalmic socket, 64.5% of patients had an acquired anophthalmic socket, and dermis-fat graft was performed as a secondary procedure in 61.3% of patients. Postoperative complications included lagophthalmos (22.6%), graft necrosis (17.7%), pyogenic granuloma (12.9%), decreased graft size (12.9%), malpositioned lids (3.2%), and volume deficiency (3.2%). The prosthesis was held in place in 49 patients (79%) preoperatively and in 55 patients (88.7%) postoperatively. Dermis-fat graft is an excellent option for congenital or acquired as well as primary or secondary anophthalmic sockets, with or without contraction. The outcomes are favorable, and complications are rare.

Anophthalmic Sockets in Retinoblastoma: A Single Center Experience.

To evaluate outcomes of anophthalmic sockets in retinoblastoma at a tertiary care center in Singapore. A retrospective study. Patients who underwent enucleation as sole/part of treatment for retinoblastoma were reviewed at our center from 2005-2017. Details including demographics, grouping and staging, adjuvant therapy, surgery, implant, and complications were collected. Of 42 patients with retinoblastoma managed over the period, the anophthalmic sockets of 31 patients who underwent enucleation were analyzed. Mean age at enucleation was 2 years. Twenty-three enucleations were performed at our institution and 8 enucleations had been performed elsewhere. Seventeen patients (52%) had porous polypropylene, 9 patients (27%) had polymethylmethacrylate, 1 patient (3%) had glass implant, and 3 (9%) had dermis fat graft. The sizes of implants varied from 10 to 20 mm. Twelve patients had attempts at globe salvation before enucleation. Out of 28 patients with primary orbital implants, 3 had implant exposure. The rates of repeat surgery among patients with and without primary implant were 66.67% (2 out of 3) and 10.7% (3 out of 28), respectively. One patient had postenucleation socket syndrome with stock eye. Five patients referred for enucleation were conservatively managed. Anophthalmic sockets in retinoblastoma have long-term implications if the primary procedure is not performed well. While the majority had good outcomes (structural and esthetic), a minority had complications requiring intervention. Ophthalmologists managing retinoblastoma must be aware of these. Primary implant had favorable outcome with minimal complications.

Dermal-fat graft for anophthalmic socket in children enucleated for retinoblastoma

Abstract Retinoblastoma is the most frequent intraocular tumor in childhood. The definitive treatment is enucleation. The management of the anophthalmic socket consists in the use of a plastic implant. The problem is that they are expensive and they usually extrude. The use of dermal-fat grafts minimizes the hemi-facial hypoplasia. They usually grow with the face, and help to expand the orbital bones, thus avoiding the psychological and physical consequences. Objective To determine if there is hemi-facial hypoplasia, using MRI images after the use of a dermal-fat implant in patients enucleated for RB. Method The study included patients enucleated for RB in which a dermal-fat implant was used and MRI images were taken in the period between June 2010 and December 2012. Facial growth and cosmesis was measured. Results The study included 12 patients, aged between 6 and 41 months. After 24 months of follow up, none of them developed hemifacial hypoplasia. All had a good cosmesis with the prosthesis. There were no complications after the surgery. Conclusions The use of dermal-fat implant is a good option for the anophthalmic socket in patients with RB after enucleation.