Reconstruction of orbital exenteration defects by INTEGRA® dermal substitutes and skin graft.

Abstract

 

Purpose

 

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.

 

Methods

 

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.

 

Results

 

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.

 

Conclusions

 

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.

 

 

INTEGRA® sutured to skin edges and placed into the cavity

 

 

Cavity totally epitheliazed 5 weeks after exenteration

 

Keywords: 631 orbit • 744 tumors