Dermis-fat graft in orbital surgery

The dermis-fat graft is composed of dermis and appended subcutaneous fat, after removal of the epidermis. It is a technique that offers the advantages of an autologous graft, with no risk of infectious transmission, no cost, and excellent cosmetic and functional results. The disadvantages include a certain lack of predictability, and the presence of a donor site. It is best used as a primary procedure in selected patients, in case of enucleation, evisceration or exenteration. It is less predictable, but sometimes still the best option in secondary procedures, such as socket reconstruction, orbital implant extrusion and correction of the post-enucleation socket syndrome. The most important technical aspect to respect is the vascular supply of the recipient bed, and avoidance of any unnecessary cautery. Proper suture techniques are also of importance to prevent complications. Complications are usually minor, but frequent.