Acellular Dermal Substitutes for Lining the Exenterated Orbit—A Systematic Review and Meta-Analysis of Clinical Outcomes

Orbital exenteration reconstruction remains a major reconstructive challenge because of the orbit's complex anatomy and its close relationship with the paranasal sinuses, which predispose patients to delayed healing. Traditional approaches, such as secondary intention healing or split-thickness skin grafting, may result in prolonged epithelialization and can compromise timely prosthetic rehabilitation. Acellular dermal matrices (ADM) have emerged as biological scaffolds that provide immediate coverage of the defect while preserving an open orbital cavity suitable for prosthetic fitting. A systematic review of the literature was conducted using PubMed/MEDLINE, Scopus, and Google Scholar to identify clinical studies reporting orbital exenteration reconstruction using ADM. Eligible studies included clinical series describing postoperative healing, prosthesis fitting, and complications. Ten studies encompassing 42 patients were identified, of which 4 retrospective cohort studies, including 36 patients, provided sufficient data for quantitative synthesis. Pooled analysis demonstrated a prosthesis fitting rate of 85%, with a mean time to complete re-epithelialization of ∼10 weeks. Reported complications were infrequent, including sino-orbital fistula, delayed healing, and cerebrospinal fluid leak. The use of radiotherapy did not appear to significantly affect epithelialization time or prosthetic outcomes. Overall, available evidence suggests that ADM may represent a useful adjunct for lining exenteration defects limited to the bony orbital framework, facilitating earlier epithelialization while maintaining conditions favorable for prosthetic rehabilitation. Given the rarity of orbital exenteration, the low-to-moderate quality of included studies, the heterogeneity of reconstructive strategies, and the lack of comparative studies, these findings should be considered exploratory, and larger prospective or comparative studies are needed to better define the role of ADM within the reconstructive algorithm.