Advances in biotechnology continue to introduce new materials for reconstruction of orbital floor fractures. Which material is best fit for orbital floor reconstruction has been a controversial topic. Individual surgeon preferences have been supported by inconsistent inconclusive data. The purpose of this study was to assess and analyze published evidence supporting various materials used for orbital floor reconstruction and to develop a decision-making algorithm for clinical application. A systematic literature review was performed from which 48 studies were selected after primary and secondary screening based on set inclusion and exclusion criteria. This cumulatively included 3475 separate orbital floor reconstructions. Results revealed risk and benefit profiles for all materials. Autologous calvarial bone grafts, porous polyethylene, and polydioxanone (PDS) were most widely used for orbital floor reconstruction. Increased infection rates were reported with polyglactin 910/PDS composites and silastic rubber. Ocular motility was reduced most with lyophilized dura and PDS. Preoperative and postoperative rates for diplopia and enophthalmos varied among the materials. In conclusion, our results revealed continued inadequate evidence to exclusively support the use of any one biomaterial/implant for orbital floor reconstruction. Results have served to create a decision-making algorithm for clinical application. Our authors propose certain parameters for future studies seeking to demonstrate a comparison between 2 or more materials for orbital floor reconstruction.

This study demonstrates significant differences in the rate of infection between the groups of patients undergoing the first stage of two-stage implant-based breast reconstruction who received postoperative antibiotic prophylaxis and the group that received only perioperative antibiotics. This study suggests that the optimal duration of postoperative antibiotic prophylaxis is at least 48 hours.

Incisions used for orbital floor exploration continues to remain a topic of controversy. Historically, 3 incisions have been used for orbital floor repair: transconjunctival, subciliary, and subtarsal. Past studies have attempted to stratify the superiority of one incision over the others. Insufficient level of evidence and inconsistent methodology have lead to inconclusive data. Our authors performed a systematic review of literature to assess the quality of evidence in literature and recommend guidelines for incisions for repairing orbital fractures. Thirty-one articles were identified, comprising a total of 4688 incisions. Technique along with individual benefits and complication profiles for each incision is reviewed. Objectivity and follow-up time intervals are necessary parameters for evaluating incisions for orbital floor exploration to further define guidelines.