Orbital Reconstruction After Repeat Orbital Exenteration

Orbital Reconstruction After Repeat Orbital Exenteration from Dr. Jagannath Boramani

1. Orbital Reconstruction after Repeat Orbital Exenteration HIMIKA GUPTA*# , DEEPA NAIR 1 * ASST. PROFESSOR IN OPHTHALMOLOGY, MGM UNIVERSITY,NAVI MUMBAI #OCULAR ONCOLOGIST, SPECTRA EYE CARE CLINIC, SECTOR 5 ,BELAPUR,NAVI MUMBAI 1.ASST. PROFESSOR, TATA MEMORIAL CANCER CENTRE,MUMBAI

2. CASE • 8 month/Female • Exenterated for orbital teratoma • Temporalis muscle flap reconstruction done • Eyelid skin lining • Recurrent disease abutting the cavernous sinus • Wound infection

3. Intra operatively • Infected Lacrimal sac • No remnants of temporalis muscle identified • Minimal CSF leak at apex • Complete tumour resection • Unhealthy lid skin resected Options for exenteration defect reconstruction  Lid skin  Granulate  Split skin graft  Temporalis muscle Flap

4. Ideal reconstruction Cushion the exposed cavernous sinus structures Plug the CSF leak Avoid infection Ensure defect is closed Avoid daily dressings(infant) ?Adequate Vascularization Dermis Fat Graft

5. Post operative POD#7 POD#14POD#7 • Donor site healed • No sloughing • No infection • No signs of uptake

6. POD # 70 - ‘Auto’ debridement Superficial layer of dermis and fat did not ‘take’ and sloughed off 2.5 months post surgery, leaving behind a defect covered with vascularized fat and healing skin epithelial margins

7. Healing defect • Placental extract • Collagen • Minimal use of antibiotics

8. Dual action of DFG for exenteration Temporary biological dressing till skin epithelialises (Subsequently sloughed off) + Live fat graft Incorporated to provide volume and cushioning

9. Review of literature • Dermis Fat Graft on a vascular bed of temporalis muscle # • Biological dressings for temporary wound closure.* # Shore JW, Burks R, Leone CR Jr, McCord CD Jr. Dermis-fat graft for orbital reconstruction after subtotal exenteration. Am J Ophthalmol. 1986 Aug 15;102(2):228-36. *May SR. The effects of biological wound dressings on the healing process. Clin Mater. 1991;8(3-4):243-9.

10. Conclusion • Reconstruction of repeat exenteration – challenging • Exposed dura/Infancy , lack of eyelid skin or temporalis muscle limited the choice of graft • Dermis fat graft acts as Dual action- temporary biological dressing + soft tissue graft.

11. Acknowledgement • Skull Base Clinic Team • Pediatric DMG Team Tata Memorial Cancer Centre, Mumbai THANK YOU ! spectraeyeclinic@gmail.com himika.gupta@gmail.com