Augmentation of Orbital Volume for Prosthesis Support Utilizing Autologous Fat Transplantation
Battlefield blast injuries to the craniofacial region can result in devastating injury patterns. One such example is damage to the globe requiring enucleation. Reconstruction of these injuries with prostheses can be complex and requires a multidisciplinary approach often involving Ophthalmology, Occuloplastics, Oral and Maxillofacial Surgery, and Maxillofacial Prosthodontics. In the Wounded Warrior population, one complication we have encountered is the loss of orbital and facial volume that compromises the support for a globe prosthesis as well as the cosmetic outcome. Our group has overcome this challenge utilizing autologous fat transplantation.
Methods:
A case review was completed following multispecialty intervention in the case of a traumatic globe injury resulting in loss of the globe. Specialties/Subspecialties in the collaborative effort include Ophthalmology, Occuloplastic, Oral and Maxillofacial Surgery, and Maxillofacial Prosthodontics. Data analyzed included mode of injury, amount of fat transferred, number of procedures and a review of complications. The following Wounded Warrior was treated at Walter Reed National Military Medical Center in Bethesda, MD.
Results:
One Wounded Warrior underwent two autologous lipotransfers to the periorbital region following initial healing from his enucleation. Orbital architecture and overall facial volume were successfully improved via autologous lipotransfer to the periorbital, infraorbital and nasolabial regions. The patient had objective improvement of prosthesis fit as well as subjective improvement in overall cosmesis. There were no significant complications to report from the procedures.
Conclusions:
Autologous fat grafting has proven to be effective in the treatment of scars by clinically improving contour deformities, softening texture and adapting hue to the uninjured adjacent skin. Adipose tissue can be an abundant source of pluripotent stem cells. Fat transfer can be designed to recontour scars, soften and reduce hypertrophic deformities such as induration, involutions, and deep furrow, and as in this report, treat an orbit with periorbital hollowing. This case presents a multidisciplinary approach to the restoration of the periorbital region after orbital enucleation, utilizing an ocular prosthesis and lipotransfer.
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