Reconstruction of the Irradiated Orbit with Autogenous Fat Grafting for Improved Ocular Implant

BACKGROUND: Soft-tissue augmentation of irradiated sites has posed numerous challenges to craniofacial reconstructive surgeons. Irradiated and enucleated orbits are challenging, especially when attempting to prime the orbit for a future prosthesis. The authors document a series of successful autologous fat injections in irradiated orbits of patients with primary tumors of the orbit, using the Coleman fat grafting technique. METHODS: Six patients underwent serial autologous fat grafting after irradiation to the orbit and enucleation. The amount of fat transferred to the periorbita was measured. For measuring fat retention, the authors used surface area analysis of the images and three-dimensional photography. Outcomes were measured by physicians and patients on a scale of 0 to 4. Also, fat retention in these irradiated patients was compared with that of nonirradiated patients who had malar fat injections for cosmetic purposes. RESULTS: Patients had a mean of three fat injection procedures with a mean of 24 cc per injection. After serial fat grafting, four of the six patients were successfully fitted for orbital prostheses. Outcomes measured by physicians and patients were a mean of 3.1 and 3.3, respectively. Retention in the postoperative period was initially similar between the nonirradiated orbit (81 percent retention) and the irradiated orbit (78 percent retention) but differed at long-term follow-up (72 percent versus 38 percent). CONCLUSION: Autologous fat grafting may be used for improved ocular implantation to the irradiated enucleated orbit.