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   Table of Contents      
ORIGINAL ARTICLE
Year : 1990  |  Volume : 38  |  Issue : 2  |  Page : 88-91

Skin grafting in severely contracted socket with the use of 'Compo'


Dr.R.P. Centre for Ophthalmic Sciences, A.I.I.M.S., New Delhi- 110 029, India

Correspondence Address:
S M Betharia
R.P. Centre. A.I.I.M.S., New Delhi - 110029.
India
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Source of Support: None, Conflict of Interest: None


PMID: 2201626

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  Abstract 

The results of split thickness autologous skin grafting along with the use of a dental impression material (Compo), a thermoplastic substance are presented in a series of 11 patients of acquired, severely contracted, anophthalmic sockets. Only the fornix fixation sutures and the central tarsorrhaphy were employed for the proper placement of graft without the use of retention devices. Artificial eyes were successfully fitted and retained subsequently after 6 weeks of grafting.


How to cite this article:
Betharia S M, Kanthamani, Prakash H, Kumar S. Skin grafting in severely contracted socket with the use of 'Compo'. Indian J Ophthalmol 1990;38:88-91

How to cite this URL:
Betharia S M, Kanthamani, Prakash H, Kumar S. Skin grafting in severely contracted socket with the use of 'Compo'. Indian J Ophthalmol [serial online] 1990 [cited 2019 Dec 8];38:88-91. Available from: http://www.ijo.in/text.asp?1990/38/2/88/24538



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  Introduction Top


A severely contracted socket with obliteration of two or more fornices along with gross fibrosis and granuloma formation is unable retain the artificial eye and hence poses an important surgical challenge. The mucous membrane grafting is not successful in such cases because of the limitation in getting an adequate amount of graft and its marked postoperative shrinkage. Various authors [1],[2],[3],[4],[5] have tried split thickness skin grafting in such cases with complicated retention devices with variable results. In this communication we are reporting the results of autologous split-thickness skin grafting and the use of thermoplastic dental material called `compo' alongwith fornix fixation sutures in cases of severely contracted socket.


  MATERIAL & METHODS Top


11 patients with acquired anophthalmic variety of con­tracted socket without bony contraction were taken up for this study. Horizontal and vertical dimensions of the palpebral aperture, depth of lower fornix in the centre, height of upper fornix at the junction of middle and outer third were measured by a transparent scale under topi­cal anaesthesia and were compared with the opposite normal eye. The volume of the socket was estimated by instillation of sterile normal saline by a syringe and the reading was recorded when the first drop over­flowed.

The bed in the anophthalmic contracted socket was then prepared by excising the cicatricial and granulation tis­sue after performing lateral canthotomy and cantholysis. The whole of conjunctiva was excised but the caruncle and the plica-semilunaris were spared.

A 5 to 7.5 cms size, medium thickness (0.04 to 0.05 cm) split skin graft was obtained from the inner aspect of the arm with the help of a Humby's knife. Tarsal conjunctiva was scraped with the blade of the Bard Parker knife for better adhesion of the skin graft. Hemostasis in the socket bed was ensured before the application of graft. The graft was then placed with the epidermal surface outward on a wooden board. Then an acrylic conformer of appropriate size was selected and sterilized along with `Compo' by immersion in Cidex solution for 4 hours. The selected conformer was then placed over its centre and marks applied with the gentian violet for the pas­sage of 2 fornix fixation sutures, one mark 1 cm above the superior margin of the conformer and the other 1.5 cm below the inferior margin. The graft was then placed in the socket with the raw surface towards the bed and fornix fixation sutures were passed with 4-0 silk on an 18 mm, half curved cutting needle for anchorage of the graft to the orbital periosteum.

The dental material `compo' was softened by immersion in water at 50 0 C and kneaded on to the back of the conformer [Figure - 1] and was placed in the graft lined socket immediately. Fornix fixation sutures were then tied. The excess of graft was trimmed and the edges were sutured to the posterior lid margins with interrupted 6-0 silk sutures. Temporary tarsorrhaphy in the centre was done and pressure bandage was given after ex­pressing any fluid collection between the bed and the graft or graft and the conformer. The bandage was opened on the 8th postoperative day. Sutures were removed after 3 weeks.


  Observations Top


The details of the clinical picture of the cases studied, the dimensions of the socket and the changes in the socket volume are given in [Table - 1][Table - 2] and depicted graphically in graph 1,11 and III. A minimum of 2 fornices were obliterated in all patients. In 5 cases all the fornices were affected. There were no complications en­countered in 5 cases. The various postoperative com­plications seen included hematoma formation in 1 case, granulation tissue in 3 cases, infection in 1 case, shallow lower fornix in 2 cases and rugosities in the graft in 3 cases (see [Table 3]). There was no extrusion of the prosthesis during the follow up period of 3 to 9 months [Figure - 2][Figure 3].


  Discussion Top


In this study a dental impression material 'compo' has been successfully used along with the acrylic conformer. 'Compo' helped in maintenance of the proper apposition of the graft to the bed by eliminating the dead space and gave shape to the socket with slight convexity of the floor.

This thermoplastic substance, compo softens on immer­sion in hot water and hardens to a rigid mass on cool­ing [6]. It satisfies all the criteria for the ideal soft tissue substitute. It is also cheap and available locally unlike guttaparcha and R.T.V. Silicone. Its use in orbital reconstruction has not been reported though it was used in facio-maximally prosthetics.

We did not find it necessary to use the various retention devices and the fixation by stainless steel wire as described in the past. We employed only upper and this thermoplastic substance, compo softens on immer­sion in hot water and hardens to a rigid mass on cooling [6].

It satisfies all the criteria for the ideal soft tissue sub­stitute. It is also cheap and available locally unlike lower fornix fixation sutures for anchorage of the graft to the periosteum along with a tarsorrhaphy in the centre and pressure bandage for 3 weeks.

None of the earlier workers have actually measured the fornices or volume and evaluated their results in terms of these parameters either of the socket or the fellow eye pre-operatively and postoperatively. The alteration in the volume of the socket and the fornices took place only upto 6 weeks. This can be explained on the basis of electron microscopic findings of the disappearance of myofibroblast population which was responsible for con­traction of scar tissue of 6 weeks period after split skin grafting. Therefore, the conformer can be substituted by the prosthetic eye as early as 6 weeks time instead of 3 to 4 months time [7]sub . Contraction of the graft was better indicated by changes in the fornices than the volume because the granulation tissue formation affects the latter. The hair growth was sparse [Figure - 4]. We did not encounter entropion, foul smelling discharge, sag­ging of lower lid or graft failure in our patients.


  Summary Top


The results of split thickness autologous skin grafting along with the use of a dental impression material (Compo), a thermoplastic substance are presented in a series of 11 patients of acquired, severely contracted, anophthalmic sockets. Only the fornix fixation sutures and the central tarsorrhaphy were employed for the proper placement of graft without the use of retention devices. Artificial eyes were successfully fitted and retained subsequently after 6 weeks of grafting.

 
  References Top

1.
Guibor,P. Contracted sockets in problems and treatment of con­tracted sockets, exenterated orbits and alkali burns. Gougelman, vol.1, Pg.1 1 1973.  Back to cited text no. 1
    
2.
Vistnes, L.M. and Iverson, R.E. Surgical treatment of contracted socket. Plast. and Reconstr. surg. 53:563-566. 1974.  Back to cited text no. 2
    
3.
Fox, S.A. Socket repairs in ophthalmic plastic surgery. Grune and Stratton, 449-461, 1976.  Back to cited text no. 3
    
4.
Mustarde, J.C. The eye socket in repair and reconstruction in orbital region, Churchill Livingstone, 21 5-226,1980.  Back to cited text no. 4
    
5.
Stallard, H.B. The eyelids and reconstructive surgery in Stallard's eye surgery, M.J. Roperhall K.M. Varghese Co. 254-267, 1980.  Back to cited text no. 5
    
6.
Peyton, F.A. Impression materials in restorative dental materials. C.V. Mosby Co. 150-154, 1960.  Back to cited text no. 6
    
7.
Rodolph, R. Inhibition of myofibroplast by skin graft. Plast. Reconstr. Surg., 63:474-480, 1979.  Back to cited text no. 7
    


    Figures

  [Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5]
 
 
    Tables

  [Table - 1], [Table - 2]


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  In this article
Abstract
Introduction
MATERIAL & METHODS
Observations
Discussion
Summary
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