The Effect of Autologous Dermis-fixation to Orbital Periosteum in Superior Sulcus Deformity

PURPOSE: To evaluate the efficacy of autologus dermis-fixation on the orbital periosteum in patients with superior sulcus deformity. METHODS: From September 2005 to February 2007, an appropriate amount of a rolled autologus dermis was added to the site of superior sulcus deformity by means of fixation to the orbital periosteum via lid crease incision. Four patients had superior sulcus deformity after undergoing evisceration or other ocular surgeries. RESULTS: Superior sulcus deformities in all patients could be corrected satisfactorily with bilateral symmetry. During the follow-up period, no complications such as mechanical ptosis and recurrence of superior sulcus deformity were observed. CONCLUSIONS: The authors believe that autologus dermis-fixation to the orbital periosteum might be a useful method to correct superior sulcus deformity without disturbing movement of the upper eyelid. A study with a larger series of patients and longer follow-up period might be necessary in the future to obtain more information about autologous dermis-fixation to the periosteum in patients with superior sulcus deformity.

Tissue Reaction in Response to Augmentation of Soft Tissue Defects According to the Dermis Graft Materials in Rabbits

The augmentation of soft tissue defects is one of the critical problems in the oral and maxillofacial surgery. Various types of graft materials, both autologous and non-autologous, have been used for the augmentation of soft tissue in the facial region. However, it is not easy to choose an ideal material for soft tissue augmentation because each has its advantages and disadvantages. An ideal graft material should meet the following criteria : it should not leave a scar at the area from which it was taken; should have less likelihood of causing infection; should feel natural after implanted; and should be not absorbed. Among the materials meeting these criteria, human dermis and artificial dermis are commonly used for clinical purposes. The present study was aimed to investigate and compare the resorption rate and the histological change following the use of the autologous dermis, the human homogenous dermis Alloderm(R), and the artificial dermis Terudermis(R) to reconstruct the soft tissue defect. Twenty mature rabbits of either sex, weighing about 2 kg, were used. Each rabbit was transplanted with the autologous dermis, Alloderm(R), and Terudermis(R) size 1 x 1-cm at the space between the external abdominal oblique muscle and the external abdominal oblique fascia. They were then divided into 4 groups (n=5 each) according to the time elapsed after the surgery: 1, 2, 4, and 8 weeks. The resorption rate was calculated by measuring the volume change before and after the transplantation, and H-E stain was preformed to observe the histological changes. The resorption rate after 8 weeks was 21.5% for the autologous dermis, 16.0% Alloderm(R), and 36.4% Terudermis(R), suggesting that Alloderm(R) is the most stable while Terudermis(R) is the most unstable. In microscopic examinations, the autologous dermis graft was surrounded by inflammatory cells and showed foreign body reactions. The epidermal inclusion cyst was observed in the autologous dermis graft. Terudermis(R) and Alloderm(R) demonstrated neovascularization and the progressive growth of new fibroblast. The results suggest that Terudermis(R) and Alloderm(R) can be availably for substituting the autologous dermis.

Management of Exposed Porous Orbital Implant with Autogenous Dermis Graft

PURPOSE: This study was to evaluate the effectiveness of autogenous dermis graft in managing the exposed porous orbital implants. METHOD: Nine cases with exposed orbital implants(hydroxyapatite or Medpor(R)) were included in this study: six cases with hydroxyapatite and the remaining three cases with Medpor(R). Each of the cases was repaired with autogenous dermis graft. RESULTS: The mean follow-up was 13.3 months. Of nine cases, seven implants remained covered at the last visit. During the follow-up period, three of them received a second dermis patch graft surgery for re-exposure. The final success rate was 77.7%. CONCLUSION: These results suggested that autogenous dermis graft served as an excellent material for repair of the exposed porous orbital implants.

A Case of Medpor(R) Orbital Implant Infection

PURPOSE: Porous orbital implant Medpor(R) which is made of polyethylene is being widely used currently. Compared with previously used porous orbital implants, it is somewhat preferred due to cheaper and easier usage but reports on its postoperative complications are not sufficient. We report the first case of Medpor(R) infection developed domestically. METHODS: A 20 year-old male patient was admitted with Medpor(R) infection 14 months after Medpor(R) orbital implant insertion. He was treated with antibiotics. RESULTS: Infection was controlled with antibiotics without implant removal. Implant exposure occurred after infection control so dermis graft was done.