Free flaps in orbital exenteration: a safe and effective method for reconstruction

Abstract

The aim of this study was to investigate the course of reconstructive treatment and outcomes with use of free flaps after orbital exenteration for malignancy. Charts of patients who had free flap reconstruction after orbital exenteration were retrospectively reviewed and the surgical technique was evaluated. Demographics, histology, surgical management, complications, locoregional control, and survival were analyzed. We performed 22 flaps in 21 patients. Reconstruction was undertaken mainly with anterolateral thigh (56 %), radial forearm (22 %), or parascapular (22 %) free flaps. Complications occurred in 33 % of patients and the flap's success rate was 91 %. The 5-year locoregional control and survival rates were 42 and 37 %, respectively. Free tissue transfer is a reliable, safe, and effective method for repair of defects of the orbit and periorbital structures resulting from oncologic resection. The anterolateral thigh flap is a versatile option to reconstruct the many orbital defects encountered.

Reconstrucción de cabeza y cuello mediante colgajos libres microvascularizados. Indicaciones, aspectos técnicos y resultados

“…En artículos previos [15][16][17] hemos expuesto nuestra experiencia en estos casos con las particularidades propias de la región. En la reconstrucción de la hipofaringe la utilización de CLM, principalmente del CLAL, consigue unos resultados funcionales satisfactorios, con cifras de fístulas faringocutáneas y de estenosis del 15 y del 9%, respectivamente, inferiores a las obtenidas con el CLAR (20 y 11%, respectivamente) y comparables a las obtenidas con un CLM de yeyuno.…”

“…En relación con la reconstrucción de la base del cráneo, la utilización de CLM permite realizar grandes resecciones para conseguir már-genes libres de enfermedad, con menos complicaciones. Los CLM ayudan a obtener un cierre dural eficaz, a aislar y rellenar cavidades (evitar infecciones y la herniación de estructuras intracraneales), a restaurar la vía aérea y/o digestiva, y a reconstruir la órbita y la superficie osteocutá-nea craneofacial 17,18 .…”

“…En términos de control de la enfermedad, los resultados obtenidos a nivel de la base del cráneo y de la hipofaringe nos llevan a concluir que los CLM permiten cierto control de la enfermedad a nivel locorregional 8,[15][16][17][18] . Sin embargo, dado el mal pronóstico de la mayoría de los pacientes que precisan un CLM para su reconstrucción, las tasas de supervivencia a los 5 años son bajas.…”

The Fusion of Craniofacial Reconstruction and Microsurgery

“…Options for soft-tissue periorbital reconstruction include the lateral circumflex femoral, ulnar forearm, and radial forearm flaps. 35,37,38 We prefer the ulnar forearm flap because of the thin soft-tissue envelope and a long (>5 cm) pedicle. The lateral circumflex femoral flap is indicated for larger defects requiring more bulk and a longer pedicle.…”

“…34 Knowledge of periorbital bone and soft-tissue anatomy is imperative for reconstruction. 35,36 The goals of periorbital year-old man with a history of glioblastoma multiforme that was successfully treated with surgical resection, chemotherapy, irradiation, and a titanium cranioplasty with a lateral circumflex femoral artery-based flap at an outside institution. He presented to our clinic with exposed mesh, purulent drainage, and exposed dura.…”