Secondary reconstruction of posttraumatic orbital deformities.

A retrospective analysis of our experience, techniques, and concepts for the secondary reconstruction of orbital injuries to 78 patients over a 15-year period is presented. Secondary orbital reconstruction has the following four basic steps: (1) freeing of the overlying soft tissues by extensive subperiosteal dissection; (2) skeletal reconstruction, usually with onlay bone grafting and contour osteoplasty; (3) restoration of palpebral shape and position by medial and lateral canthopexy; and (4) soft-tissue refinement. Reconstruction required an average of at least two operations. In this series, there were no mortalities, three infections, and no reoperations for bleeding. Thirty patients required a second operation to an area previously addressed reflecting inadequacies in technique, the unpredictability of bone grafts, and soft-tissue scarring. Distortion of the skeletal infrastructure is most amenable to secondary reconstruction. Soft-tissue distortions that accompany bone malposition are less well corrected. Soft-tissue contraction is the limiting factor in successful reconstruction dictating separate movement of the overlying soft tissues and ligaments, their overcorrection, and subsequent revisional surgery. Secondary orbital reconstruction, although providing significant improvement, usually fails to restore the preinjury appearance, and usually falls short of properly performed acute reconstruction.