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Background: Graves' ophthalmopathy is a chronic, multisystem disorder characterized by increased intraorbital fat tissue and hypertrophic extraocular muscles caused by an autoimmune process. Graves' ophthalmopathy represents the most frequent extrathyroidal manifestation of Graves' disease. Clinical findings are impaired ocular motility, diplopia, lid retraction, and impaired visual acuity up to optic neuropathy, with menacing blindness., Methods: Transpalpebral decompression by intraorbital fat removal was first described by Olivari in 1988. From 1984 to 2004, a consecutive series of 1635 patients (3210 eyes) with Graves' ophthalmopathy underwent this operation at the authors' institution. The medical records of 1374 patients (84 percent) could be evaluated retrospectively., Results: Postoperatively, the majority of patients showed significant improvements of major symptoms such as ocular protrusion, diplopia, decreased visual acuity, swelling of the eyelids, retrobulbar pressure, and headache. In addition, complications-most of them temporary and reversible-were rare. Because the osseous orbita is not touched, no complications, such as penetration of the dura, infection of the sinus maxillaris, meningitis, irritation of the infraorbital nerve, or obstruction of the lacrimal system, were observed. However, the high number of additional eyelid corrections (average, 2.5 individual corrections) following the decompression indicated the complexity of surgical treatment in endocrine orbitopathy., Conclusion: Transpalpebral decompression has proved to be reliable, effective, and safe, with good, lasting results leading to an improvement not only in visual function but also in the patient's personal well-being and social life, with a high-benefit-to-low-risk ratio.

From 1984 to October 1989 at the Plastic Surgery Unit in Wesseling, we carried out 147 operations on 75 patients with Graves' disease. Intraorbital fat was removed through a transpalpebral incision to achieve decompression. The average amount of fat was 6.0 cm3. We have made a long-term follow-up (more than 6 months postoperatively) study of 57 patients who experienced 108 operations. The first results were published in September 1988. When we compared the results to a traditional decompression operation (with resection of one or two orbital walls), we found that the postoperative complication rate was significantly lower and that the success rate was much higher. Thus the range of indications for surgery may be much wider than previously considered. Patients who are about to lose their vision as well as those experiencing lesser symptoms can be much improved with this operation. At the beginning, before the technique was fully developed, complications such as supraorbital nerve palsy occurred.

Experiences with 30 latissimus dorsi flaps are described. Used either as a muscle flap, as a myocutaneous flap, or as an "island" of skin nourished by a subcutaneous pedicle of muscle and vessels, the flap has an excellent blood supply and is suitable for many repairs of defects of the chest wall.