Dermis fat grafts autogenous dermis fat grafts as a secondary implant following extrusion.

1. Dermis fat grafts

2. ‫بسم‬‫الرحمن‬ ‫هللا‬‫الرحيم‬
‫انك‬ ‫ماعلمتنا‬ ‫اال‬ ‫لنا‬ ‫العلم‬ ‫سبحانك‬ ‫قالو‬
‫العليم‬ ‫انت‬‫الحكيم‬
‫االيه‬ ‫البقره‬ ‫سورة‬32) )

3. Case presentation
Ramadan Elgohary
Resident of ophthalmology
Al Azhar university

4. Case presentation
• Male patient 30 yrs. old presented by
extruded ball with severely deficient sclera.
• Past history of right eye evisceration 2 yrs
ago.
• The pt has history extruded ball twice time
after primary surgery .
• Pt was admitted and demis fat graft
implatation was done.

5. Preoperative

6. Gluteal dermis fat graft

7. Insersion of dermis fat graft into
socket

8. Suturing the conjunctiva into graft

9. One weak postoperative of dermis fat
graft

10. Dermis fat grafts (DFG)
•
• Smith and Petrelli (1978) first described the use
of autogenous dermis fat grafts as a secondary
implant following extrusion.
• DFG used as a primary implant, the use of dermis
fat graft has been described following ocular
enucleation.

11. Dermis fat grafts (DFG)
• Complications associated with alloplastic
implants like migration or extrusion are avoided.
• The DFG is composed of dermis and
subcutaneous fat, after removal of the epidermis.
• The dermis is believed to enhance vascularization
and decrease the incidence of fat atrophy. It also
acts as a barrier against fatty augmentation.

12. Dermis fat grafts (DFG)
• The site most frequently used as graft is the
gluteal area outer upper quadrant but other
areas such as the lower abdomen , the
periumbilical and over anterior superior illiac
spine can also be used

13. Surgical techniques
• A 25-mm circle is outlined on the inferior
quadrant of the abdomen or on the upper
outer quadrant of the buttock. The circle is
extended to form an ellipse to facilitate
wound closure.
• 10 ml of 0.5% Bupivacaine with adrenaline
are injected injected intra dermally in the
anterior abdominal wall at the proposed
site of the graft excision to create a “peau
d’orange” appearance

14. Surgical techniques
• A skin incision is made along the
marks and the epidermis
carefully shaved off the
proposed graft in a single sheet
using a no. 15 blade.
• The pale dermis should now
show multiple fine bleeding
points .

15. Surgical techniques
• The dermis was excised with the diameter of the fat ball
measuring 20 mm, and underlying fat to a depth of 25
mm to obtain a cylindrical shape.
• The wound is closed using interrupted subcutaneous
4/0 Vicryl sutures and interrupted 4/0 prolin sutures for
the skin.

16. Surgical techniques
• The graft is subsequently cut to the desired
shape required for a socket implant
• The socket is prepared and dissected as for a
secondary spherical implant.

17. Surgical techniques
•The dermis was
trimmed to fit the
scleral opening .
•The fat portion of the
dermis-fat graft was
placed into the scleral
shell

18. Surgical techniques
• The conjunctiva is sutured to the front surface
of the graft with interrupted 6/0 Vicryl sutures
leaving an area of the graft bare in the
presence of socket contracture.
• In the absence of a lining deficit the conjunctiva is closed over the
dermis fat graft.
• A surgical conformer of appropriate size and shape is placed
ensuring that the eyelids close passively.

19. Surgical techniques
• The ocular wound was dressed and
bandage for 3 days post operatively.
• The gluteal wound from where the dermis
fat graft was examined and the sutures
were removed 1 week postoperatively.
• At 6 weeks postoperatively, the patient
received an ocular prosthesis.

20. Drawback???
• Fat resorption ?
Contracted socket.
• Fat augmentation?
Useful in children.
Can be avoided by presence of dermis superiorly.
• Female ??
Gleatel or abdominal wound.

21. Thank you