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S. Garg, J. Tao, R. Burgett, W. Nunery; Supramid "Sled" Implant Repair Of Combined Medial Wall And Orbital Floor Fractures . Invest. Ophthalmol. Vis. Sci. 2006;47(13):3792.
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Orbital medial wall and floor fractures often occur concomitantly in the facial trauma patient. These multi–wall fractures pose treatment dilemmas since the area of total fracture may be large and since the infero–medial orbital strut may be compromised. Traditional approaches often fail to reconstitute normal orbital anatomy and patients remain at risk for diplopia, enophthalmos, implant migration, and poor cosmesis. We report a technique of implanting of supramid sterile nylon foil (S. Jackson, Inc. Alexandria, VA) to repair combined medial wall and orbital floor fractures that offers optimum outcomes and low morbidity.
Fifteen consecutive orbits (of fourteen patients) with combined medial wall and floor fractures were treated using a 0.4mm supramid implant placed in a "sled technique via both a modified Lynch incision and an inferior palpebral conjunctiva approach.
In all fifteen patients, repair was successful with no diplopia, loss of pre–operative vision, significant enopthalmos, or hypoglobus. There were no complications with the implant such as migration, hemorrhage, or infection. The surgical scars were well hidden and tolerated by all patients
The "sled" technique for implanting supramid across a combined medial wall and orbital floor fracture is highly effective in reconstructing the orbit. The two–point stable–fixation resists implant migration and also achieves orbital content support in the infero–medial orbit in the face of a violated buttress. Our initial data suggests that the supramid "sled" implant technique allows for optimal restoration of orbit anatomy and facial appearance after combined medial wall and orbital floor fractures. Further investigation is warranted.
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