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Sutureless repair of orbital fracture may limit postop complications
Ophthalmology. 2009;116(1):135-138.
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Unsutured orbital fracture repair yielded a low incidence of postoperative complications and showed promise for transconjunctival repair of isolated orbital floor and complex orbital fractures.
"Although some authors advocate meticulous closure of the periorbital tissue and conjunctiva, sometimes in a layered fashion, to prevent implant migration, others have commented that such closure, especially in the setting of traumatically disrupted soft tissue planes, may lead to an increase in postoperative eyelid dystopia," the study authors said.
The study included 85 eyes of 82 patients who underwent transconjunctival repair of isolated floor fractures (38 eyes) or complex orbital fractures (47 eyes) without conjunctival closure.
Investigators followed patients for an average 318 days after surgery (range, 82 days to 978 days). Data showed no cases of postoperative orbital implant exposure, infection or migration, and no granulomatous inflammation from the migration of ointment into soft tissue.
"In our experience, the 'sutureless' transconjunctival approach to orbital floor and rim fractures combines adequate surgical exposure and acceptable aesthetic results and is associated with a low rate of complications," the authors said. "[We] do not claim any advantage over more conservative tissue closure. However, the 'sutureless' technique seems to be a viable alternative to the multilayered periosteal conjunctival closure."
Closure of the periorbita and conjunctiva may not be necessary after transconjunctival approach orbital floor and rim fracture repair. The tissues remain in good apposition without suturing and heal well without repair. Forgoing suture closure of these tissues does not result in a higher incidence of wound dehiscence, implant migration or other complications.
Forgoing closure of the periosteum may shave 1 to 2 minutes off of the surgical time and may prevent minor complications from sutures such as granuloma formation. Many oculoplastic surgeons have already abandoned conjunctival closure for a decade or longer. Similarly, other transconjunctival approaches to the orbit, such as orbital decompression or complex fracture repair, may not require suture closure of the periobita or conjunctiva.
– Julian D. Perry, MD
OSN Oculoplastic and Reconstructive Surgery Board Member