SURGICAL TECHNIQUES

Autologous dermis graft at the time of evisceration or enucleation

M Reza Vagefi¹, Tristan F W McMullan¹, John R Burroughs², David K Isaacs³, Angelo Tsirbas³, George L White Jr⁴, Richard L Anderson¹ and John D McCann¹

¹ Center for Facial Appearances, Salt Lake City, Utah, USA
² Eye and Facial Appearances, Colorado Springs, Colorado, USA
³ Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, California, USA
⁴ Department of Family and Preventative Medicine- Public Health, University of Utah, Salt Lake City, Utah, USA

Correspondence to:
John D McCann, MD, PhD, 1002 E South Temple, Suite 308, Salt Lake City, Utah 84102, USA; doctorface{at}gmail.com

Aim: To present a new technique using autologous dermis graft at the time of enucleation or evisceration to replace the ocular surface area lost when the corneal scleral button is excised.

Methods: A retrospective, interventional, non-comparative case series of patients who had an autologous dermis graft placed to assist in closure of Tenon’s capsule and conjunctiva at the time of enucleation or evisceration. Medical records were reviewed and the following variables were recorded: age, sex, history of previous ocular surgery or radiation treatment, indication for surgery, type of surgery, laterality, type of orbital implant, size of implant, length of follow up, and complications.

Results: Nine patients were identified (three male, six female) Five had enucleation with implant placement and four had evisceration with implant placement. Four individuals received unwrapped porous polyethylene spherical implants, three received silicone implants, and two received hydroxylapatite implants. Follow up ranged from 30 to 112 weeks (mean (SD), 61 (28) weeks). No operative or early complications were observed. One patient who had enucleation after two rounds of brachytherapy for uveal melanoma developed subsequent late exposure of the implant. There were no complications involving the graft donor site.

Conclusions: This small series shows that the use of a dermis graft is a safe and effective new technique to facilitate orbital rehabilitation. It is hypothesised that the extra surface area produced with a dermis graft preserves the fornices and allows a larger implant. It may also allow the implant to be placed more anteriorly which assists with both implant and prosthesis motility.

Keywords: enucleation; evisceration; dermis graft; orbital implant; anophthalmos

Competing interests: JDMcC is the creator of the McCann Medical Matrix and has a financial interest in the software.

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