Patel Sagar Y, Tamboli Diana A, Mancini Ronald
Division of Oculoplastic and Reconstructive Surgery, Department of Ophthalmology, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, USA.
Int Ophthalmol. 2018 Apr;38(2):833-836. doi: 10.1007/s10792-017-0525-3. Epub 2017 May 4.
Describe a novel two-stage orbital exenteration technique using an INTEGRA dermal regeneration matrix.
A 63-year-old Hispanic male presented with multiple invasive right eyelid masses that incisional biopsy revealed was infiltrative basal cell carcinoma. The patient underwent a right orbital exenteration without lid sparing. An INTEGRA graft was sutured in place to cover the defect at the time of surgery and allowed to vascularize for 3 weeks. During this time, frozen section of tumor margins previously read as negative were found to have invasive basal cell carcinoma on permanent section re-evaluation. Three weeks after the initial exenteration, the patient returned to the operating room and the dermal matrix of the INTEGRA graft was found to be well integrated and vascularized. Further resection was performed in the areas which were found to have residual cancer on permanent section evaluation. After preliminary frozen section pathology demonstrated clear margins, full-thickness skin grafts harvested from the right and left supraclavicular regions were thinned, draped, and fixated over the INTEGRA matrix.
The patient recovered well and experienced no immediate postoperative complications. Adjuvant radiotherapy began 5 weeks after initial exenteration with a fully epithelized exenterated socket. At postoperative week 16, our patient remained with full epithelization after completing radiation. As of postoperative week 47, our patient has had no complications.
The use of INTEGRA with full-thickness skin grafting for orbital exenteration reconstruction presents several advantages over traditional reconstruction approaches including: quicker recovery, tumor surveillance by re-examining edges of the resection after INTEGRA dermal placement, easier postoperative care, and earlier initiation of radiation therapy.
描述一种使用INTEGRA真皮再生基质的新型两阶段眼眶内容剜除术技术。
一名63岁的西班牙裔男性因右侧眼睑多发浸润性肿物就诊，切开活检显示为浸润性基底细胞癌。患者接受了不保留下眼睑的右侧眼眶内容剜除术。手术时将INTEGRA移植物缝合到位以覆盖缺损，并使其血管化3周。在此期间，最初冰冻切片显示肿瘤边缘阴性，但在永久切片重新评估时发现有浸润性基底细胞癌。初次眼眶内容剜除术后3周，患者返回手术室，发现INTEGRA移植物的真皮基质已良好整合并血管化。在永久切片评估发现有残留癌的区域进行了进一步切除。初步冰冻切片病理显示切缘清晰后，从左右锁骨上区域采集的全厚皮片进行修剪、覆盖并固定在INTEGRA基质上。
患者恢复良好，术后无即刻并发症。初次眼眶内容剜除术后5周，眼眶完全上皮化后开始辅助放疗。术后第16周，患者完成放疗后仍保持完全上皮化。截至术后第47周，患者无并发症。
使用INTEGRA联合全厚皮片进行眼眶内容剜除术重建比传统重建方法具有几个优点，包括：恢复更快、在放置INTEGRA真皮后通过重新检查切除边缘进行肿瘤监测、术后护理更容易以及更早开始放疗。
