Socket Reconstruction

Overview

A contracted socket poses a management dilemma for the physician and is often a major aesthetic concern for the patient. Findings consistent with a contracted socket include extensive loss of conjunctiva, deep scar formation, atrophy of the orbital fat, and fornix contraction. Successful reconstruction of the contracted socket requires that a stable fornix with adequate depth be established by increasing the surface area with the use of grafts. Several graft materials, such as oral mucosa, skin, dermis-fat, and hard palate mucosal grafts have been previously described for use in socket reconstruction. The major disadvantage of all these grafting procedures is harvesting of tissue from another site of the same patient, where its availability may be limited. It also requires additional surgical skill and instrumentation. Further, once shrinkage and fibrosis of the socket begin, the patient may require repeated surgical interventions over time to maintain an adequate socket for prosthesis wear.

Amniotic membrane (AM) has been used successfully in fornix reconstruction after symblepharon lysis in cicatricial pemphigoid, Stevens Johnson syndrome, chemical burns, recurrent pterygium excision, and contracted socket. AM start gaining popularity because of favorable results produced when used in socket reconstruction. It could be an ideal graft that is abundant and easily available, without sacrificing the patients’ donor tissue. It is also well suited for eye socket reconstruction because it has both a basement membrane and a collagen matrix that can help to provide resistance to contraction. Additionally, AM is easily harvested, undergoes minimal shrinkage, has a short healing period, and with no donor site morbidity. These qualities make the AM a suitable graft for eye socket reconstruction.

Videos

AM in Socket Reconstruction Video Provided by Jorge Camara, MD