Reconstruction of Large Orbital Exenteration Defects after Resection of Periorbital Tumors of Advanced Stage

Abstract

Orbital exenteration is a devastating procedure because of the social impact and psychological stress put upon the patient. Besides cancer ablative surgery, reconstruction after removal of the tumor constitutes a major problem and the final aesthetic result is quite important. Both obliteration of the orbital cavity and continuation of the epithelial lining are required. Free rectus abdominis muscle and musculocutaneous flaps are versatile flaps which both enable filling the cavity and reconstituting the skin defect with a cutaneous portion or with a skin graft. Both free rectus abdominis muscle and musculocutaneous flaps were used for reconstruction of orbital exenteration defects in 19 patients. All suffered partial maxillectomy as well. The flaps provided satisfactory aesthetic results in all patients.

An Algorithmic Approach to Reconstructive Surgery and Prosthetic Rehabilitation after Orbital Exenteration

“…Numerous reconstructive methods that attempt to fulfill these goals have been described in case reports and small case series. [2][3][4][5][6] A comprehensive comparison of the various methods of reconstruction has not been performed, nor has the issue of how many patients desire and will ultimately use an orbital prosthesis been well studied. For example, in some series, the majority of patients have ultimately chosen to wear an eye patch rather than use an orbital prosthesis.…”

Reconstruction after extended orbital exenteration using a fronto-lateral flap

“…The main advantages of this technique are: flexibility of the free-flaps allowing for better accommodation in the defect; availability of multiple donor areas; reliable protection for the central nervous system using muscle-containing flaps; the possibility of using of non-irradiated tissues in previously treated patients; and the high success rates. Many authors have described microsurgical reconstruction of the orbit area [12][13][14][15] , and it is well-established in surgery involving the maxilla or skull base 17 .…”

Microsurgical Reconstruction of Maxillary Defects

“…[49] Several authors have described the use of free fibula osteocutaneous flaps to reconstruct combined maxillary and mandible defects. [71] we think that the prefabricated fibula can address the alveolar ridge and the palate but cannot reconstruct both the mandible and maxilla in one setting and also the prefabricated fibula cannot act as a space filling flap for upper maxillary defects (Figure 17,18). .…”