Periocular autografts in socket reconstruction

Background: Current enucleation and socket reconstruction techniques often require reinforcement of an orbital implant or wound by the use of a tissue graft. Commonly, allograft tissue (cadaveric sclera, fascia, etc.) is used. Disadvantages of allografts include possible inflammatory reaction, unpredictable vascularization rate, variable resorption, antigenicity, and cost. Another alternative to implant reinforcement is autogenous tissue which usually is harvested from a remote site (fascia lata, split dermis, temporalis fascia, pericranium, etc.). An overlooked source of readily available autogenous grafts is the connective tissue in the periorbital region and the enucleated eye itself. These sources include autogenous lamellar sclera, the corneoscleral button, capsular tissue from a migrated implant, and orbital rim periosteum. Methods: The authors used periocular autografts in primary and secondary socket reconstructions in 24 patients, with excellent success over a 2-year period. Seven autogenous corneoscleral buttons and two autogenous scleral grafts were used to cover biointegrated implant spheres. Ten implant capsules from migrated nonintegrated spheres were used to cover and reinforce secondary implants. In five patients, an autogenous periosteal graft was taken from the supraorbital rim and used to cover an exposed implant. Results: Complications included one pyogenic granuloma, one conjunctival inclusion cyst, and one recurrent exposure after a periosteal graft, which necessitated explanation and a dermis fat graft. Postoperative motility was judged to be good to excellent in 21 patients. Conclusions: These techniques are presented as a new alternative to using human bank tissue or remote incision autografts for reconstruction of the anophthalmic socket.