Dermis-Fat Grafts

DFG is usually performed under general anesthesia, and the donor site of the graft may be the lower abdomen, thigh, or inferomedial buttocks, depending on the surgeon’s preference. Local anesthesia is given to the orbit and the donor site. In cases of an extruding implant or one which has severe contractures, the conjunctiva is incised and the implant, if present, is removed. Muscle remnants within the socket should be identified if possible. This allows for greater graft survival (due to the vacularity the muscles provide to the graft) and motility of the socket. An approximate 20–25 mm diameter DFG is harvested from the donor site first by removing the epithelium. A sharp blade is then used to incise subcutaneous tissue and fat to a depth of 15–20 mm in a circular fashion. The graft is then sutured into the socket onto a vascularized source (i.e., extraocular muscles or orbital fat). The dermis is left bare to epithelialize from the surrounding conjunctiva. A temporary conformer is placed. Full epithelialization of the dermis occurs in approximately one month. An ocular prosthesis can be fitted in 2–3 months (Stewart 1995).