The consequences of dermis fat graft in the reconstruction of anophthalmic socket with large orbital implant exposure

Purpose: To present our results of dermis-fat graft as a secondary procedure after implant extrusion. Materials and Methods: A retrospective chart review was performed to examine 34 anophthalmic socket carriers undergoing dermis-fat graft. All patients had a history of ocular trauma and underwent evisceration surgery. Small defects and Grade 5 contracted sockets were not included. The patients reported the complaints of pain and discharge. Data were collected on the characteristics of the exposed implant material and surgical technique used for implant insertion; complications related with dermis-fat graft, cosmesis; and functional results such as the ability to hold an external prosthesis. For socket reconstruction, the graft was taken from the lateral upper quadrant of the gluteal region, 30% larger than the orbital defect. The mean follow-up period was 12.26 ± 1.13 months. Results: Of the 34 patients, 26 had porous polyethylene implants and 8 had acrylic implants. The average diameter of the conjunctival defect with scleral melting was 11.6 mm. The findings encountered in the follow-up of patients who underwent socket reconstruction with dermis-fat graft were as follows: graft necrosis in one patient, reduction in graft size in two patients, insufficient vascularization of the graft in one patient, ptosis in two patients, deep superior sulcus in one patient, cysts over the dermis-fat graft in one patient, and necrosis at the donor site in two patients. Except for two patients with fornices shrinkage, all of them used their ocular prosthesis well. Conclusion: Dermis-fat graft with low complication rate is a good option for anophthalmic socket reconstruction, but care of the donor site should not be neglected.