Abstract
Purpose
Describe a novel two-stage orbital exenteration technique using an INTEGRA dermal regeneration matrix.
Methods
A 63-year-old Hispanic male presented with multiple invasive right eyelid masses that incisional biopsy revealed was infiltrative basal cell carcinoma. The patient underwent a right orbital exenteration without lid sparing. An INTEGRA graft was sutured in place to cover the defect at the time of surgery and allowed to vascularize for 3 weeks. During this time, frozen section of tumor margins previously read as negative were found to have invasive basal cell carcinoma on permanent section re-evaluation. Three weeks after the initial exenteration, the patient returned to the operating room and the dermal matrix of the INTEGRA graft was found to be well integrated and vascularized. Further resection was performed in the areas which were found to have residual cancer on permanent section evaluation. After preliminary frozen section pathology demonstrated clear margins, full-thickness skin grafts harvested from the right and left supraclavicular regions were thinned, draped, and fixated over the INTEGRA matrix.
Results
The patient recovered well and experienced no immediate postoperative complications. Adjuvant radiotherapy began 5 weeks after initial exenteration with a fully epithelized exenterated socket. At postoperative week 16, our patient remained with full epithelization after completing radiation. As of postoperative week 47, our patient has had no complications.
Conclusion
The use of INTEGRA with full-thickness skin grafting for orbital exenteration reconstruction presents several advantages over traditional reconstruction approaches including: quicker recovery, tumor surveillance by re-examining edges of the resection after INTEGRA dermal placement, easier postoperative care, and earlier initiation of radiation therapy.
References
Tyers AG (2006) Orbital exenteration for invasive skin tumours. Eye 20(10):1165–1170
Mohr C, Esser J (1997) Orbital exenteration: surgical and reconstructive strategies. Graefe’s Arch Clin Exp Ophthalmol 235(5):288–295
Tufaro AP, Buck DW, Fischer AC (2007) The use of artificial dermis in the reconstruction of oncologic surgical defects. Plast Reconstr Surg 120(3):638–646
Rahman I, Cook AE, Leatherbarrow B (2005) Orbital exenteration: a 13 year Manchester experience. Br J Ophthalmol 89(10):1335–1340
Putterman AM (1986) Orbital exenteration with spontaneous granulation. Arch Ophthalmol 104(1):139–140
Naquin HA (1954) Exenteration of the orbit. AMA Archiv Ophthalmol 51(6):850–862
Donahue PJ, Liston SL, Falconer DP, Manlove JC (1989) Reconstruction of orbital exenteration cavities: the use of the latissimus dorsi myocutaneous free flap. Arch Ophthalmol 107(11):1681–1683
Ozgonul C, Grisolia ABD, Demirci H (2017) The use of integra (R) dermal regeneration template for the orbital exenteration socket: a novel technique. Ophthal Plast Reconstr Surg. doi:10.1097/IOP.0000000000000869
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
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Informed consent was obtained from the participant included in the study.
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Patel, S.Y., Tamboli, D.A. & Mancini, R. Two-stage rapid exenteration reconstruction to allow early radiation therapy for an aggressive orbital cancer. Int Ophthalmol 38, 833–836 (2018). https://doi.org/10.1007/s10792-017-0525-3
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DOI: https://doi.org/10.1007/s10792-017-0525-3