Subciliary skin-muscle flap approach in patients with orbital fractures

Abstract

Background: Selection of a suitable incision for orbital floor and medial wall fractures is one of the challenging problems in plastic surgery. The most frequently used is the subciliary step skin muscle incision with advantages including: adequate exposure and acceptable cosmetic result and disadvantages such as ectropion and skin necrosis.In this article we have tried to determine the rate of complications of this incision in a series of patients with orbital trauma that have been operated by the authors in 15khordad hospital during a three years period  (September 2000-september 2003).Methods: This retrospective review includes 52consecuative cases of orbital trauma (61 eye) referred to our center who have been operated by authors. Step skin-muscle incision approach was used for reduction and fixation of orbital rim and floor fractures .These patients have been evaluated according to causes of fractures, kind and number of incisions, hospital stay, and complications of step skin-muscle incision. The mean duration of postoperative follow-up was two years.Results: Among the 52 patients reviewed, there were 48 males and 4 females; their mean age was 29 years (range: 15-67 years). Injuries were on the left side in 25 (49%) patients, on the right side in 18(35%) patients and both sides in 9 (16%) patients. The main cause of trauma was car accident (50%). Six patients had scleral show 1-2 mm, five of them were managed by non surgical methods and the other patient reoperated for sustained ectropion. Other complications such as hematoma, visible scar, hemorrhage, and skin necrosis were not seen.

Conclusion: Potential drawback of this incision is ectropion, though with massage, squinching, and warm compress majority of them would be improved. In our series one patient was reoperated for correction of ectropion. However; it seems that subciliary step skin muscle approach produce less risk of edema and visible scar and better field of view.