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Francois Ameloot, Hicham Mezzine, Anne-Laure Jeancolas, Cedric Ghetemme, Louis Lhuillier, Adina Agapie, Oualid Guechi, Shanour Premy, Jean-Marc Perone; Reconstruction of orbital exenteration defects by INTEGRA® dermal substitutes and skin graft.. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4079.
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Orbital exenteration is a surgical procedure causing significant cosmetic and psychological consequences.Its reconstruction presents a challenge for the surgeon who must find the most effective and aesthetically satisfactory surgical process. We describe a new approach for surgical reconstruction of orbital cavity defects.
We report the case of 42 years old patient presenting an ulcerative and retractile lesion of the outer half of the right lower eyelid. Biopsy found a moderately differentiated squamous cell carcinoma and the scan showed anterior orbital cancerous infiltration. A right orbital exenteration associated with radiotherapy was decided. During the orbital emptying, extemporaneous exam showed negative margins. A INTEGRA® dermal substitute was sutured to skin and applied to the bones of the cavity with paraffin-impregnated gauze.
The integration of INTEGRA® was fast, with the fabrication of a quality collagenous tissue on bones of the orbital cavity, allowing the establishment of a free skin graft, within 3 weeks after the exenteration. After 4 weeks the cavity was totally réepithelialized and the radiotherapy could have been started only 5 weeks after the first procedure, while being perfectly well tolerated by local tissue. Bone-anchored epithesis have been adapted 2 months after the end of radiotherapy.
The use of INTEGRA ® combined with a skin graft allowed a faster, healing of the cavity and prothesis adaptation, than spontaneous epithelization. It also provides a better surveillance of cancers recurrence and less aesthetic sequelae than local muscle or cutaneous flap. INTEGRA® dermal substitutes associated with skin graft could be a fast, effective, and aesthetically satisfactory solution for reconstructions of orbital exenteration defects.
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