Use of autogenous split-thickness dermal graft for reconstruction of the lining of the exenterated orbit

A surgical technique using an exposed dermal graft to line the exenterated orbit has been successful in nine patients. Eight of the nine patients had undergone total maxillectomy at the time of exenteration. A split-thickness (epidermal) skin graft is harvested with a dermatome and hinged at one end. A second split-thickness dermal graft is harvested from the dermal bed of the first graft. The hinged epidermal graft is sutured into its donor site, and the deeper free dermal graft is used to line the orbital cavity. The latter graft tends to be more viable than a split-thickness epidermal graft. Also, because the dermal graft can self-epithelialize or be epithelialized by adjacent tissues, it may be placed adjacent to skin or a mucous membrane.