May 2004
Volume 45, Issue 13
Free
ARVO Annual Meeting Abstract  |   May 2004
Surgical treatment of the contracted socket: a technique
Author Affiliations & Notes
  • M. Goisis
    Maxillo–Facial Clinic, S.Paolo Hospital–University of Milan, Milano, Italy
  • F. Biglioli
    Maxillo–Facial Clinic, S.Paolo Hospital–University of Milan, Milano, Italy
  • M. Guareschi
    Policlinico di Monza, University of Milano–Bicocca, Milano, Italy
  • A. Coggiola
    Maxillo–Facial Clinic, S.Paolo Hospital–University of Milan, Milano, Italy
  • A. Frigerio
    Maxillo–Facial Clinic, S.Paolo Hospital–University of Milan, Milano, Italy
  • C. Tremolada
    Maxillo–Facial Clinic, S.Paolo Hospital–University of Milan, Milano, Italy
  • R. Brusati
    Maxillo–Facial Clinic, S.Paolo Hospital–University of Milan, Milano, Italy
  • Footnotes
    Commercial Relationships  M. Goisis, None; F. Biglioli, None; M. Guareschi, None; A. Coggiola, None; A. Frigerio, None; C. Tremolada, None; R. Brusati, None.
  • Footnotes
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Investigative Ophthalmology & Visual Science May 2004, Vol.45, 4710. doi:
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      M. Goisis, F. Biglioli, M. Guareschi, A. Coggiola, A. Frigerio, C. Tremolada, R. Brusati; Surgical treatment of the contracted socket: a technique . Invest. Ophthalmol. Vis. Sci. 2004;45(13):4710.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Abstract: : Purpose:A simple technique to reline grossly contracted anophthalmic sokets is presented. Methods:After the removal of the scarred mucosa of the contracted socket, an acrylic conformer shell with three drainage holes is inserted. This shell must enter closely within the new socket while permitting the eyelids to close. Two drainage tubes are inserted in the medial and lateral drainage holes and a syringe fitted with a room temperature vinyl polidiaxone impression material is affixed to the central drainage hole of the shell. Then the silicone is injected into the socket with a medium steady force. When the silicon begins to overflow, the injection is stopped and the apparatus is firmly hold until silicone is entirely vulcanized. The shell, matched with the silicon conformer and traversed by the 2 drainage tubes, is removed and draped with a full thickness hairless skin graft. Small cuts are done on the graft over the drainage tubes and the tubes are pushed out. The skin–covered conformer with drainage tubes is inserted into the orbital cavity and a tarsorrhaphy is performed. The tubes lay in the space between the graft and the recipient bed. During the first week after intervention these tubes are connected to a suction unit, creating a continuum negative pressure. Then the tubes are moved into the space between graft and comformer and used for daily irrigation. 2 months after the intervention the tarsorraphy is divided and the conformer is replaced with a prosthesis. Results:Four patients have been treated with the described technique. At six months, all patients heve been successfully able to wear a prosthetic eye with comfort and a good cosmetic appearance. Conclusions:A variety of surgical techniques have been developed to obtain a tight and stable adhesion of the skin grafts with the expanded sockets. Many authors suggest the use of skin grafts wrapped around large prefabricated conformers, that must be manufactured by a technician. The use of silicone allows to fill completely the neo–cavity and to push the graft uniformly against the recipient bed in all its surface. Many solutions have been proposed to avoid movements of the skin–wrapped conformer. In our technique the negative pressure between the skin graft and the recipient bed guarantees a tight adhesion and avoids graft movements. The continuum vacuum has the further advantage to drain off any blood, fluid or other interpositions between the recipient bed and the graft.

Keywords: orbit • pathology techniques • quality of life 
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