Closure of a large sino-orbital fistula with bioengineered collagen matrix
What:
Paper Presentation | Présentation d'article
Part of:
When:
2:34 PM, Friday 1 Jun 2018
(6 minutes)
Where:
Metro Toronto Convention Centre (South Building)
- Room 714 A
How:
Authors: Imran Jivraj, Ahsen Hussain, Navdeep Nijhawan
Author Disclosure Block: I. Jivraj: None. A. Hussain: None. N. Nijhawan: None.
Abstract Body:
Purpose: Orbital exenteration surgery may be complicated by sino-orbital fistula formation. We describe the successful use of the Integra® acellular bovine matrix in repairing a persistent sino-orbital fistula following exenteration.
Study Design: Case Report
Methods: Case Description and Review of Literature
Results: A 55 year old man with an extensive smoking history was evaluated for ocular surface squamous neoplasia after proliferation and orbital extension following brachytherapy and noncompliance with topical Mitomycin. He had previously undergone a right dacryocystorhinostomy with Jones tube insertion. A subtotal exenteration was performed with frozen section control of the margins and the socket was left to epithelialize secondarily. There was a persistent sino-orbital fistula measuring approximately 3cm in the region of the previous DCR. Closure with a paramedian forehead flap was unsuccessful. The patient refused a free flap but consented to the experimental use of an Integra® bilayer matrix over a Vicryl mesh with revision of the forehead flap. This enabled successful closure of the fistula after five months of follow-up.
Conclusions: Integra® is an acellular dressing that consists of a matrix of cross-linked bovine collagen and glycosaminoglycans covered by a semi-permeable layer of silicone. Use of dermal substitutes enables rapid re-epithelialization without incurring the risk of additional donor site morbidity and flap failure. Integra® has been widely used in reconstructive surgery; in ophthalmology there are reports of its use in repairing traumatic eyelid skin defects, lower lid retraction, and reconstruction of exenterated sockets. To the best of our knowledge, closure of a sino-orbital fistula with bioengineered dermal matrix has not been described.
Author Disclosure Block: I. Jivraj: None. A. Hussain: None. N. Nijhawan: None.
Abstract Body:
Purpose: Orbital exenteration surgery may be complicated by sino-orbital fistula formation. We describe the successful use of the Integra® acellular bovine matrix in repairing a persistent sino-orbital fistula following exenteration.
Study Design: Case Report
Methods: Case Description and Review of Literature
Results: A 55 year old man with an extensive smoking history was evaluated for ocular surface squamous neoplasia after proliferation and orbital extension following brachytherapy and noncompliance with topical Mitomycin. He had previously undergone a right dacryocystorhinostomy with Jones tube insertion. A subtotal exenteration was performed with frozen section control of the margins and the socket was left to epithelialize secondarily. There was a persistent sino-orbital fistula measuring approximately 3cm in the region of the previous DCR. Closure with a paramedian forehead flap was unsuccessful. The patient refused a free flap but consented to the experimental use of an Integra® bilayer matrix over a Vicryl mesh with revision of the forehead flap. This enabled successful closure of the fistula after five months of follow-up.
Conclusions: Integra® is an acellular dressing that consists of a matrix of cross-linked bovine collagen and glycosaminoglycans covered by a semi-permeable layer of silicone. Use of dermal substitutes enables rapid re-epithelialization without incurring the risk of additional donor site morbidity and flap failure. Integra® has been widely used in reconstructive surgery; in ophthalmology there are reports of its use in repairing traumatic eyelid skin defects, lower lid retraction, and reconstruction of exenterated sockets. To the best of our knowledge, closure of a sino-orbital fistula with bioengineered dermal matrix has not been described.
