Secondary reconstruction of the eye socket with a free radial forearm flap

We report on two patients (38 and 52 years old) suffering from severe post-enucleation socket syndrome (PESS) after enucleation of the bulbus with postoperative irradiation of the orbit due to malignant eye tumors. The secondary reconstruction of the contracted eye socket was performed by a free vascularized radial forearm flap to create a permanent eye socket with augmentation of the content of the orbital space. In the follow-up period of 12 months the patients were able to wear a cosmetically acceptable ocular prosthesis without notable secondary graft contracture. The free vascularized radial forearm flap is an alternative procedure to a dermis fat graft for the secondary reconstruction of the orbit in patients with a severe PESS.