Name of the Procedure:

Exenteration of Orbit (does not include skin graft), Removal of Orbital Contents with Muscle or Myocutaneous Flap

Summary

Exenteration of the orbit is a surgical procedure that involves removing the contents of the eye socket, including the eye, muscles, and other tissues. This particular procedure involves covering the exposed area with a muscle or myocutaneous flap rather than a skin graft.

Purpose

The procedure is typically performed to treat severe eye conditions, such as malignant tumors, severe infections, or life-threatening trauma. The goal is to remove diseased tissue to prevent the spread of cancer or infection, alleviate pain, and reduce other symptoms.

Indications

• Malignant tumors (e.g., orbital cancers)
• Severe orbital infections
• Traumatic injuries to the eye socket
• Failed previous surgeries

Suitable patients usually exhibit one or more of these conditions and have not responded well to less invasive treatments.

Preparation

• Fasting for at least 8 hours before the surgery
• Adjustments or cessation of certain medications (as advised by the physician)
• Preoperative diagnostic tests such as CT scans, MRIs, and blood tests
• Appointment with the anesthesiologist to discuss sedation options

Procedure Description

1. Administration of general anesthesia to ensure the patient is unconscious and pain-free.
2. A surgical incision is made around the orbit to access the eye socket.
3. All orbital contents, including the eye, muscles, and tissues, are carefully removed.
4. A muscle or myocutaneous flap is harvested from the patient's own tissue.
5. The flap is then positioned and secured to cover the exposed area.
6. The incision is closed with sutures, and sterile dressings are applied.

Specialized surgical tools and imaging equipment are used throughout the procedure.

Duration

The procedure typically takes between 2 to 4 hours, depending on the complexity.

Setting

This surgery is usually performed in a hospital operating room.

Personnel

• Ophthalmic surgeon
• Anesthesiologist
• Surgical nurses
• Support staff (e.g., surgical techs)

Risks and Complications

• Common risks: infection, bleeding, and scarring
• Rare risks: damage to adjacent structures, flap failure, and anesthesia-related complications
• Potential management includes antibiotics for infections, additional surgery for bleeding or scarring, and specialized care for anesthesia issues.

Benefits

• Removal of diseased or damaged tissue
• Potential pain relief and improved quality of life
• Prevention of further spread of infection or cancer

Benefits can often be realized soon after recovery.

Recovery

• Patients typically stay in the hospital for a few days post-surgery
• Follow-up appointments to monitor healing and assess for complications
• Instructions on wound care and activity restrictions
• A recovery period of several weeks to months
• Patients may require additional reconstructive surgeries or prosthetics

Alternatives

• Less invasive surgical options (if feasible)
• Radiation or chemotherapy for certain cancers
• Conservative management with medications for infections

Alternatives are considered based on their effectiveness in comparison to the extensive removal of tissues that exenteration provides.

Patient Experience

• Patients will be under general anesthesia during the procedure, so they will not feel any pain.
• Postoperatively, there may be discomfort or pain managed with prescribed medications.
• Emotional and psychological support may be necessary due to the significant impact of the procedure on body image and functionality.
• Vision loss in the operated eye is permanent, requiring adjustments and rehabilitation.

Pain management and comfort measures are explicitly planned by healthcare providers to ensure a smoother recovery.