Lilly H. Wagner, M.D., an ophthalmologist at Mayo Clinic in Rochester, Minnesota, performs a bilateral anophthalmic socket reconstruction with a dermis fat graft placement. This procedure is done on a patient who previously had enucleation of both eyes in childhood for treatment of congenital glaucoma. The patient has lost orbital volume over the years. Watch as Dr. Wagner performs this bilateral procedure ensuring that the patient can be appropriately fit for prostheses.
So this patient previously had a new creation of both eyes and had a reconstruction with orbital implants, but she developed some loss of over the volume over the years and also contraction of the changing table lining of the socket and is now unable to wear a prosthesis. We're gonna start on the right side here and just open up the content Eva and create some space for the fat graft that we will place later. We're trying to do the least amount of dissection necessary to avoid further scarring and contraction of the socket. So now we're going to do that same dissection on the other side and again measure the opening that we've made in the convent Eva to see what size of service fat graft we will be able to fit. So we're gonna turn our attention to the Durmus fat graft harvest site on the right hit. We previously marked out in the lips here, that will be adequate size. Our graphs are each 20 long, so this needs to be at least 40 long. We're just going to confirm that this will be appropriate size. We'll make our incision along the outer mark to have an elliptical shape that will close better. And we can take our two smaller a little shaped graphs from that larger one. We take the epidermis off while the tissue is still in place. It will help us to maintain adequate tension. We just for graft harvesting. Try to use an area that will provide appropriate tissue. And the second priority is to choose an area where the defect or the scar will not cause either functional deficits or be of much cosmetic concern. We don't need very much That's probably about one cm to give appropriate volume to the orbit. So we're going to in size straight down, not angle our blades so that the graft does not become tapered towards its deep surface and then excise it. We can just cut across the deep surface of the graft and a plane perpendicular to the skin surface. We use the graph that we're going to split up between the two sides and we're just going to keep that on wet gauze while we obtain human stasis here. So since we measured the same size on both sides, we can just cut the graph in half and then just reshape it a little bit so each half is more of an the lips that tapers towards the end. You can have some overlap between the content Eva and Durmus edge and does not have to precisely fit in your opening as long as it's not too small. Now we can put our graft in place, tuck the adipose tissue into the pockets we've created. And then we're going to play some deep searchers to attach the adipose tissue there from our graph to the teen ons and orbital fat. Can already see that we have improvement there of the enough thomas and the lids should be held open. Now, if there's a prosthesis fitted on top of this, The place is deep futures. We want to be careful that we don't incorporate tissues that are deep in the for nick so that we don't shorten our for nazis by pulling them up to the side of the graft. Now that we have the two corners anchored nasal and temporal. You can just add a running suture along each edge. You can see that we've increased the surface area of the socket and added depth to the cornices as well as volume. Will now repeat the same procedure on the other side. This conform er has finished rations so that any fluid that builds up behind it can come out to the surface and appointment or drops that we will put on the front of the conform. Er will get back to the tissue. We have the conformance in place. We get a little bit better idea of what it would look like with a prosthesis, the standard temperature sora fee and struck patients too. Just keep the area clean, wash it normally with soap and water and apply antibiotic ointment to these futures twice a day for two weeks until we take it out. Now we are going to finish closing our donor side