RESUMO
Orbital reconstruction following orbital trauma, tissue sacrifice from cancer resection, or other tissue loss poses a unique challenge for surgeons. Factors to consider include the patient's systemic health status, potential for adjuvant radiation, final composition, and strength of the graft, infection risk, graft rejection, status of visual function, and cosmetic outcome. In settings where a permanent artificial implant is avoided due to exposure or infection risk, potential tissue utilized includes xenografts, allografts, and autografts-each with variable benefits and drawbacks, depending on the surgical goals of the repair. We describe a case of orbital reconstruction after a gunshot wound to the left orbit using tri-layer Kerecis (decellularized intact North-Atlantic cod fish skin) with excellent globe position and maintenance of ocular motility.
Assuntos
Órbita , Procedimentos de Cirurgia Plástica , Humanos , Animais , Procedimentos de Cirurgia Plástica/métodos , Masculino , Órbita/lesões , Ferimentos por Arma de Fogo/cirurgia , Transplante de Pele/métodos , Peixes , Procedimentos Cirúrgicos Oftalmológicos/métodos , Ferimentos Oculares Penetrantes/cirurgia , Ferimentos Oculares Penetrantes/diagnóstico , Adulto , Fraturas Orbitárias/cirurgia , Fraturas Orbitárias/diagnósticoRESUMO
Operative repair of orbital fractures utilizes implants constructed of a plethora of materials that vary in cost. Surgeon preference as well as fracture complexity may dictate the implant chosen. In this study, we retrospectively compared the complication rates of the four most common types of implants utilized at our institution. We found no significant difference in complication rates in our sample of 88 patients. Additionally, the least expensive implant was as effective as the most expensive implant in addressing isolated orbital blowout fractures. This situation is not unique to the field of oculoplastics. As evidenced from published literature in other areas of surgery, from orthopaedics to orthodontics, cheaper alternatives often afford similar outcomes as more expensive options. We herein argue that a cost-effective approach should be considered while still allowing for high quality of care, in the face of rising health care costs and health disparities in America.
