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Complications of dermis-fat orbital implantation.

Primary dermis-fat implantation can be effectively performed in cases without pre-existing systemic vascular disease or orbital burns. Meticulous handling of the graft (using a Goeller trephine and Tenon's capsule traction sutures), filleting Tenon's capsule, and avoiding cautery of the graft bed may minimize graft necrosis and atrophy. Pyogenic granulomas of the conjunctival-graft interface and graft hirsutism are easily managed. Keratinization of the socket, graft wound dehiscence, donor site hematomas, and wound dehiscence are avoided with careful surgical technique. Secondary dermis-fat orbital implantation may add orbital volume and conserve the conjunctival fornices, but may also suffer a slightly increased frequency and amount of graft absorption.