Autogenous temporalis fascia patch graft for porous polyethylene (Medpor) sphere orbital implant exposure

Abstract

Background: Temporalis fascia has been recommended for hydroxyapatite sphere exposure. The aim of this study was to identify potential risk factors for exposure of porous polyethylene (Medpor) sphere implants and evaluate the use of autogenous temporalis fascia as a patch graft for exposure.

Methods: A retrospective review of consecutive cases of porous polyethylene sphere orbital implant exposure.

Results: Five cases presented between May 2000 and October 2001 (three males, two females; mean age 44.5 years). Three had enucleation (two with primary implants) and two had evisceration (one with primary implant). Exposure occurred in one primary, two secondary, and two replacement implants. Orbital implant diameter was 20 mm in four cases and 16 mm in one case (contracted socket). The mean time from implantation to exposure was 23 months (range 0.7-42.6). Three patients had secondary motility peg placement before exposure. The average time from last procedure (sphere implant or peg insertion) to exposure was 3 months (range 0.7-12.6). Four patients required surgical intervention, of which three needed more than one procedure. Autogenous temporalis fascia grafting successfully closed the defect without re-exposure in three of these four patients. The grafts were left bare in three patients, with a mean time to conjunctivalise of 2.4 months (range 1.6-3.2).

Conclusions: Exposed porous polyethylene sphere implants were treated successfully with autogenous temporalis fascia graft in three of four patients. This technique is useful, the graft easy to harvest, and did not lead to prolonged socket inflammation, infection, or extrusion.

Figure 1

(A) Diagram showing layers of the scalp overlying the temporalis muscle. (B) Diagram showing incision for harvesting the deep temporalis fascia: the incision is made within the hair line, in a line from the tragus of the ear. (C) Peroperative view of deep temporalis fascia. (D) Cross section of the completed surgery—temporalis fascia is left to conjunctivalise, unless conjunctiva and Tenon’s fascia can be advanced.

Figure 2

Clinical example: case 2. (A) Chronic exposed anterior surface of Medpor implant. (B) Creation of a pocket under the conjunctival/Tenon’s edge, to take the temporalis fascia graft. (C) The conjunctiva is then sutured to the anterior edge of the graft, in this case, leaving an area of bare fascia. (D) Healed postoperative appearance—the area of bare temporalis fascia over the exposed Medpor has completely conjunctivalised.

Figure 3

Treatment algorithm for Medpor (porous polyethylene) sphere implant exposure.