Wrapping hydroxyapatite orbital implants with posterior auricular muscle complex grafts

PurposesThe study is to describe a new surgical technique for correcting large orbital implant exposure with extraocular muscle flaps and to propose a treatment algorithm for orbital implant exposure.MethodsIn a retrospective study, seven patients with orbital implant exposure were treated with extraocular muscle flaps. All data were collected from patients in Chang Gung Memorial Hospital, Taiwan during 2007–2012. All surgeries were performed by one surgeon (Y.J.T). Patient demographics, the original etiology, details of surgical procedures, implant types, and follow-up interval were recorded. Small exposure, defined as exposure area smaller than 3 mm in diameter, was treated conservatively first with topical lubricant and prophylactic antibiotics. Larger defects were managed surgically.ResultsSeven patients consisting of two males and five females were successfully treated for orbital implant exposure with extraocular muscle flaps. The average age was 36.4 (range, 3–55) years old. Five patients were referred from other hospitals. One eye was enucleated for retinoblastoma. The other six eyes were eviscerated, including one for endophthalmitis and five for trauma. Mean follow-up time of all seven patients was 19.5 (range, 2–60) months. No patient developed recurrence of exposure during follow-up. All patients were fitted with an acceptable prosthesis and had satisfactory cosmetic and functional results.ConclusionsThe most common complication of orbital implant is exposure, caused by breakdown of the covering layers, leading to extrusion. Several methods were reported to manage the exposed implants. We report our experience of treating implant exposure with extraocular muscle flaps to establish a well-vascularized environment that supplies both the wrapping material and the overlying ocular surface tissue. We believe it can work as a good strategy to manage or to prevent orbital implant exposure.

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“…Wrapping the implant decreases the irritating effects of uneven surface and also reduces implant exposure, migration or extrusion. [3].…”

Section: Introductionmentioning

confidence: 99%

Use of Extraocular Muscle Flaps in the Correction of Orbital Implant Exposure

et al. 2013

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“…They reported excellent implant motility and good vascular ingrowth in each patient. Naugle et al [18] reported that no extrusion and only 2 (2.4%) implant exposures were observed in a total of 83 eyes, in cases using posterior auricular muscle complex with a mean follow-up of 36 months. Although these autogenous tissues have many benefits, the drawback is the need for another operation.…”

Section: Discussionmentioning

confidence: 99%

The Use of Autogenous Sclera as Wrapping Material in Hydroxyapatite Implantation

et al. 2008

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Purpose: To report postoperative results and effectiveness using autogenous sclera as a wrapping material for hydroxyapatite orbital implant. Methods: A chart review of 78 patients (78 eyes) undergoing primary enucleation or a secondary procedure using autogenous sclera as a wrapping material from March 1997 to October 2004 was undertaken. Primary enucleation was performed in 54 eyes and secondary implantation in 24. In severely constricted eyes or eviscerated eyes with small implants, the sclera was unfolded and used for wrapping only on the anterior surface of the implant. Results: The average size of implants was 19.7 mm in diameter, and all the 78 implants were over 18 mm. During an average postoperative follow-up of 18 months, complications such as implant exposure, infection or extrusion did not occur in any case. Conclusion: This study shows that autogenous sclera is a safe, effective wrapping material for hydroxyapatite orbital implants with no serious complications.

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“…Autologous materials have the advantage of reduced risk of transmission of viral infections but they need additional surgery on the patient to harvest these tissues that can leave scars that the patients may not be happy with 8 and also cause complications like vascular compromise to the ear during harvesting of posterior auricular membrane. 5 Wound dehiscence is one of the potential complications in the use of orbital implants. Dehiscence rates of 0-40% have been reported with various wrapping materials in numerous studies.…”

Section: Discussionmentioning

confidence: 99%

“…Various wrapping materials like donor human sclera, 2 polyester heart fibre patches, 3 rectus abdominis sheath, 4 posterior auricular muscle, 5 vicryl mesh, 6 and bovine pericardium have been used. 7 Processed bovine pericardium has the added advantage of being available in a sterilized prewrapped form and autologous tissue does not need to be harvested.…”

Section: Introductionmentioning

confidence: 99%

Bovine pericardium (Tutopatch) wrap for hydroxyapatite implants

Gupta

Lyon

Singh

et al. 2006

Eye

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Purpose To evaluate bovine pericardium (Tutopatch s ) as a wrapping material for hydroxyapatite implants in patients undergoing enucleation for uveal melanoma. Method Prospective cohort study of patients who had enucleation for uveal melanoma between January 2003 and August 2003 were included in the study. Any patient with less than 3 months follow-up was excluded. Enucleation was performed under general anaesthesia followed by insertion of hydroxyapatite implants wrapped in bovine pericardium (Tutopatch). The recti muscles were sutured directly to the wrap. The tenon's capsule and conjunctiva were closed in two layers. A conformer was inserted at 1 week and artificial eye at 2-3 months. The patients were followed up regularly and were assessed for cosmetic result, exposure of implant, and the need for any further surgical procedures. Results A total of 19 patients (seven male and 12 female) were included in the study. Median age at diagnosis was 63 years (range 38-80 years). Median follow-up was 26 months (range 22-30 months). No patient developed postoperative complications of wound dehiscence. The overall cosmetic result was excellent in all the patients. The rate of postoperative complications compared favourably with published data using other wrapping materials/implants. Conclusion Tutopatch s is a safe wrapping material for hydroxyapatite orbital implants in patients undergoing enucleation for uveal melanoma.

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Wrapping hydroxyapatite orbital implants with posterior auricular muscle complex grafts

Cited by 41 publications

References 11 publications

Use of Extraocular Muscle Flaps in the Correction of Orbital Implant Exposure

Use of Extraocular Muscle Flaps in the Correction of Orbital Implant Exposure

The Use of Autogenous Sclera as Wrapping Material in Hydroxyapatite Implantation

Bovine pericardium (Tutopatch) wrap for hydroxyapatite implants

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