Surgical management of acquired socket contracture.

PURPOSE OF REVIEW: In a cosmetically oriented world, the inability to retain an ocular prosthesis remains a psychologically devastating problem for patients. This study reviews the recent advances in the management of acquired socket contracture.

RECENT FINDINGS: For mild contracture, several recent studies describe the beneficial use of amniotic membrane as a substrate graft to allow the conjunctival epithelium to migrate and multiply. To correct moderately severe socket contracture, quilting sutures are typically used to ensure survival of mucous membrane grafts, which are required to provide adequate lining to the socket. In cases of severe socket contraction, irradiated sockets, and recurrent socket contraction, radial-free forearm flaps or a variety of other flaps in association with bone expansion osteotomies are on the rise.

SUMMARY: Techniques to treat contracted sockets continue to evolve; however, large multicenter trials as well as an updated classification scheme are needed to devise standardized treatment protocols.