Tarsal patch-flap for orbital implant exposure

The authors determine the efficacy of a new technique, the tarsal patch- flap, in the management of postenucleation and postevisceration porous orbital implant exposures that are recalcitrant to other surgical approaches. All patients treated during a 30-month period with recurrent orbital implant exposures who failed at least one surgical attempt at defect closure were treated using a tarsal patch-flap, a fornix-based tarsoconjunctival flap from the upper eyelid. Eight patients, six after enucleation and two after evisceration, were treated with a tarsal patch-flap. Five implants were porous polyethylene and three were hydroxyapatite. The defect size ranged from 4 mm to 12 mm (largest dimension). All eight patients have maintained closure of their defects for a mean follow-up of 13.8 months (range, 4-30 months). The vascularized tarsal patch-flap provides an excellent alternative surgical approach to the management of recurrent orbital implant exposures recalcitrant to Tenon-conjunctival advancement and autologous fascia grafting.