Orbital Dermis-Fat Graft Transplantation: Results in Primary and Secondary Implantation

Abstract

Objectives: Autologous dermis fat graft (DFG) is being used in both primary and secondary socket surgeries. In the present study, we aimed to evaluate patients' satisfaction and possible intra-and postoperative complications in patients who had DFG transplantation. Ma te ri als and Met hods:In this retrospective study, the results of 17 patients who were operated between October 2008 and October 2012 were evaluated. Of these cases, 7 had primary and 10 had secondary DFG. Patient satisfaction was evaluated by asking the patients to fill out a questionnaire graded from 1 (not satisfied) to 4 (very satisfied). Additionally, the incidence of complications and requirement for another operation was noted. Re sults: The average patient age was 30.5±17.9 years. Patients with primary grafts were 100% satisfied with the outcome and could wear their prosthesis without any discomfort. In this group, one patient had delay in epithelialisation of the graft and ptosis, which was treated with frontal sling surgery and artificial tears. In patients with secondary grafts, 6 patients (60%) were satisfied with the outcome. Four patients were not satisfied from the result. One had inferior lid laxity; however, after lateral tarsal strip surgery, she could wear her prosthesis. Another patient developed inferior forniceal adhesion. He was treated with mucous membrane grafting and artificial tears and could wear his prosthesis. One patient had infection and contraction of the socket due to inappropriate postoperative medication use. Following repeated DFG transplantation, he was able to wear his prosthesis. Another patient had fat atrophy prior to secondary DFG transplantation and developed atrophy of the graft following surgery. Her family refused additional surgery. This patient could not wear any prosthesis. Conclusion: According to our results, we believe that DFG transplantation is successful in primary implantation. In secondary cases, correct patient selection is important to achieve good outcome. (Turk J Ophthalmol 2015; 45: 65-70) Key Words: Dermis-fat graft, patient satisfaction, socket surgery Amaç: Otolog dermis-yağ grefti (DYG) primer ve sekonder soket cerrahilerinde kullanılmaktadır. Biz bu çalışmamızda DYG implantasyonu geçirmiş olguları, hasta memnuniyeti ve cerrahi sırası ve sonrasındaki komplikasyonlar açısından değerlendirmeyi amaçladık. Ge reç ve Yön tem: Retrospektif planlanan çalışmamızda Ekim 2008 ile Ekim 2012 arasında opere olan 17 olgu incelendi. Bunlardan 7 olguya primer, 10 olguya sekonder DYG implante edilmişti. Hastaların memnuniyeti bir sorgulama formunda derecesi 1 (memnuniyetsiz) ile 4 (çok memnun) arasında bir değeri seçmesi istenerek değerlendirildi. Ayrıca komplikasyonlar, sıklıkları ve farklı bir cerrahi ihtiyaçları not edildi. Bulgular: Olguların yaş ortalaması 30,5±17,9 yıl idi. Primer DYG implante edilmiş olguların memnuniyeti %100 düzeyindeydi ve protezlerini bir rahatsızlık olmadan kullanıyorlardı. Bu grupta sadece bir hastada epitelizasyonda gecikme ve pitozis gelişmişti ve tedavisinde için fr...

Outcomes of secondary autologus dermo-fat orbital implants in anophthalmic sockets

“…We had two patients with complications, one of them, a child, had fornix contraction with fat resorption after DFG, which we believed was due to the history of radiotherapy for retinoblastoma. This effect of radiation, leading to fat resorption and/or fat atrophy was also seen by Karatas et al 15 Our one adult female patient had fornix scarring and conformer extrusion, for unexplainable reason, however the cause of loosing her eye was trauma.…”

“…The final outcome, patient satisfaction and the rate of complications were evaluated. We found out that 10 (83.3%) out of 12 of our DFG patients were satisfied with the aesthetic and functional outcome, whereas Karatas et al 15 evaluated 17 patients out of which 10 patients were operated for secondary DFGs and reported 60% (6 patients) of the patients being satisfied with the results with no major complications, and four patients (40%) were not happy with outcomes.…”

Efficacy, safety and complications of autologous fat grafting to the eyelids and periorbital area: A systematic review and meta-analysis

“…One study conducted by Huang et al [ 22 ] evaluated the cosmetic results using the 5-point Likert scale (1, very unsatisfied; 2, unsatisfied; 3, neutral; 4, satisfied; 5, very satisfied), and the mean score awarded for patients was 4.702, which was significantly higher than the midpoint value of 3 (average) on the 5-point scale, indicating that patients were mostly satisfied with their overall postoperative improvement. Karataş et al [ 33 ] evaluated patients’ satisfaction by a questionnaire graded from 1 (not satisfied), 2 (mildly satisfied), 3 (moderately satisfied), and 4 (very satisfied). Grades 1 and 2 were accepted as dissatisfaction and grades 3 and 4 were accepted as satisfaction for the data analysis.…”

Quantitative Assessment of Periocular Autologous Fat Transfer Survival Using 3D Stereophotogrammetric Imaging

“…18 Postoperative complications such as graft hirsutism, conjunctival cysts, or granulomas are relatively common. 19 DFG is associated with highly variable outcomes, particularly in patients undergoing secondary DFG procedures 20 Previous studies have suggested that the volume augmentation after AFT in the anophthalmic socket can last up to 5 years postoperatively as demonstrated on MRI imaging and photography. 21 However, DFG procedures can offer distinct advantages when both lining and volume augmentation are required.…”