Avoiding complications following primary dermis-fat orbital implantation.

Primary dermis-fat orbital implantation can be performed successfully in cases without preexisting systemic vascular disease or orbital burns. Meticulous handling of the graft (using a Goeller trephine and Tenon's traction sutures), filleting Tenon's capsule and avoiding cautery of the graft bed may minimize graft necrosis and atrophy. Conjunctival granuloma formation and hair growing within the socket are easily managed. Keratinization of the socket, graft wound dehiscence, and donor wound hematomas are avoided with careful surgical technique.