Defect Components and Reconstructive Options in Composite Orbitomaxillary Defects With Orbital Exenteration

The maxillary artery as a recipient vessel option for complex midface and anterior skull base microsurgical repair: A cadaveric study

“…Free tissue flaps have become a mainstay of reconstruction in head and neck oncological resections generating larger or complex defects (Brown & Shaw, 2010; Chia et al, ; Grammatica et al, ; Yu et al, ). Primary recipient vessel selection in midface or anterior skull base defects includes the ipsilateral superficial temporal and facial arteries that successfully accommodate a variety of flap vascular pedicles (Chia et al, ; Iyer et al, ; Joseph et al, ; Valentini et al, ; Yazar, ). Yet, there are less common situations where alternative vessel options are needed, for example, the use of shorter‐pedicled osteomyocutaneous flaps.…”

“…The armamentarium of tissue flaps available for reconstructive options in head and neck defect repairs is extensive (Brown & Shaw, 2010; Grammatica et al, ; Hanasono et al, ; Iyer et al, ; Joseph et al, ; Jung et al, ; Thakker & Fernandes, ; Valentini et al, ; Yetzer & Ferandes, ). One of the commonly utilized techniques for reconstruction of orbitomaxillary defects involves filling it with a muscle soft tissue free flap from donor sites such as the rectus abdominus or anterolateral thigh which may be further covered with either a soft tissue skin flap or a fitted spectacle‐mounted orbital prosthesis (Joseph et al, ). Orbitomaxillary or anterior skull base defects are relatively remote from lower branches of the external carotid system which are used ordinarily as recipient vessels for head and neck microvascular transfer.…”

“…There are several osteomyocutaneous free flaps that have been evaluated by recent studies to assess their benefits and drawbacks in reconstruction procedures (Iyer et al, ; Joseph et al, ; Tan, Wong, & Chen, ; Valentini et al, ). The more commonly used flaps in recent literature include the fibula, radius, iliac crest, and scapular (Iyer et al, ; Joseph et al, ; Tan et al, ; Valentini et al, ). While such flaps have been effective in providing suitable restoration of malar features as well as good orbital rim and floor support, flap bone manipulation and fixation frequently results in a shorter pedicle length.…”

“…While such flaps have been effective in providing suitable restoration of malar features as well as good orbital rim and floor support, flap bone manipulation and fixation frequently results in a shorter pedicle length. This downside becomes particularly evident when larger segments of bone graft must be used in defect repair (Iyer et al, ; Joseph et al, ; Valentini et al, ; Yazar, ).…”

Prosthetic Reconstruction of Orbital Defects

“…Autologous free flaps, such as from the radial forearm, rectus abdominus, or anterolateral thigh, can provide vascularized tissue coverage of the wound bed in addition to tissue bulk to fill the cavity. 10 Currently, the only tissue option for complete reconstruction of the exenterated orbit is a facial transplant, which is not a feasible option for many reasons in many patients.…”