Combined porous implant and thin dermis fat graft for complex socket reconstruction

Purpose. Complex socket deformities may be encountered during either primary enucleation or secondary reconstruction, and may be complicated by implant migration, implant extrusion, socket contraction, orbital inflammation, or poor orbital vascularity. We performed combined porous implant and thin dermis fat graft in order to evaluate the acceptability of this procedure in restoring both sufficient orbital volume and sufficient conjunctival surface area. Methods. A total of six patients underwent socket reconstruction with combined porous implant and thin dermis fat graft. One case was performed at primary enucleation and the remaining five cases were performed during secondary reconstruction/revision. Post-operative follow-up ranged from six months to three years. Porous implants consisted of either hydroxyapatite or porous polyethylene. Results. None of the six patients have had complications of implant extrusion, implant migration, failure of the dermis fat graft, or socket contraction. Post-operative MRI scans showed viability of the dermis fat graft and vascularization of the porous implant. All six patients have been fitted with a prosthesis, which has been worn without complications. Conclusions. Combined porous implant and thin dermis fat graft is an acceptable surgical procedure for socket reconstruction in which sufficient orbital volume and conjunctival surface area are of primary concern. This procedure can be performed at either primary enucleation or secondary reconstruction, with good post-operative results and little risk of complications.