Efficacy and safety of an artificial dermal graft for the reconstruction of exenterated sockets: a preliminary report

Purpose The purpose of this study is to report our experience with the use of artificial dermis grafts for orbital socket reconstruction following orbital exenteration (OE). Method A retrospective study was conducted in our ocular oncology centre from May 2018 to June 2020 in patients undergoing OE for orbital malignancies in whom an artificial dermis device (Integra® template, 2 layers) was used for reconstruction. Data recorded included demographics, previous and adjuvant treatments, aetiologies, surgical procedure, surgical reconstruction, complications and follow-up. The main outcome measure was the time between OE and the full granulation of the cavity. Results Ten patients (mean age, 71.3 years [43–92]) were included. Tumours originated from the conjunctiva ( n = 5, 50%), eyelid ( n = 3, 30%) and orbit ( n = 2, 20%). Nine patients underwent total OE, and one required enlarged OE. Orbital reconstruction was performed using an artificial dermis alone ( n = 9, 90%) or combined with regional flaps ( n = 1, 10%). The mean granulation time was 3.3 weeks (2–4). Three (30%) patients received adjuvant radiotherapy 1 month post-surgery. The mean time to spontaneous epithelialization was 9.4 weeks (6–12). Preoperative and postoperative radiotherapy was not associated with a delayed epithelialization of the socket ( p = 0.463 and p = 0.236, respectively). One (10%) and 2 (20%) patients experienced postoperative socket infection and an ethmoidal fistula, respectively. The mean follow-up was 11.6 months (6–16). Conclusion Using artificial dermis grafts alone or with regional flaps appears to be a viable surgical procedure for orbital socket reconstruction. They reduce surgical morbidity and hospital stay. Preoperative and postoperative radiotherapy does not seem to delay socket healing.