Reconstruction of Orbital Exenteration Defect With Cheek or Combined Cheek and Forehead Advancement Flaps

Abstract

Purpose: To review the outcomes of orbital exenteration defect reconstruction using cheek or combined cheek-forehead advancement flap. Methods: Charts of 14 patients who underwent reconstruction of the exenterated orbit with cheek advancement flap were reviewed. In surgery, a cheek flap elevated via a nasofacial sulcus incision, and preperiosteal dissection was advanced over the defect. The upper orbital defect, if necessary, was covered with a forehead flap, which was dissected through an incision in the midline or temporal forehead and advanced inferiorly. Results: In all patients (7 women, 7 men; mean age, 65 years), total (n = 7) or extended (n = 7) exenteration was performed for a malignant tumor. In 12 patients (86%), the defect was primarily closed with cheek flap alone (n = 6) or cheek plus forehead (n = 6) advancement flaps. Eight patients received radiotherapy before and after surgery. Four patients (29%) had a total of 6 postoperative complications (skin graft infection, orbital cavitary abscess, osteomyelitis, chronic skin ulcer, and 2 sino-orbital fistulae). The mean follow-up duration was 43 months (range, 11–79 months). Conclusions: Cheek advancement flap can be used alone or together with a forehead advancement flap to cover the orbital defects after total or extended exenteration. This repair may be resistant to radiotherapy-related complications in some cases.

Reconstruction of the Exenterated Orbit with an Island Pericranial Flap: A New Surgical Approach

“…[14][15][16][17][18][19][20][21][22][23] There is no consensus about the height at which the periosteal vessels end, and hence, avascularity of the flap is imminent. [15][16][17][18][19][20][21][22][23][24] Necrosis has never been observed after orbital reconstruction with periosteal flap surgery when the dissection extended beyond the border of the hairline. However, this may occur, as in any flap design, and its frequency could only be judged by a far larger number, as in our study.…”

“…[12][13][14][15][16] The use of a pericranial rotation flap pedicled at the medial forehead for lining the cavity after orbital exenteration is a novel approach, though. [17][18][19] The delicate periosteal layer is particularly suitable for reconstruction in the facial area. An epidermal layer is harder to adjust to the complex concave cavity and therefore has not been considered.…”

“…Integration of larger-lumen veins into the pedicle may play a greater role in the case of more voluminous cutaneous grafts. [14][15][16][17][18][19][20][21][22][23] There is no consensus about the height at which the periosteal vessels end, and hence, avascularity of the flap is imminent. [15][16][17][18][19][20][21][22][23][24] Necrosis has never been observed after orbital reconstruction with periosteal flap surgery when the dissection extended beyond the border of the hairline.…”

“…Integration of larger-lumen veins into the pedicle may play a greater role in the case of more voluminous cutaneous grafts. 14–23…”

An unwanted disfiguring eye surgery: Exenteration

“…This repair may be resistant to radiotherapyrelated complications in some cases. 6 As the eyes are the most important components of the face regarding aesthetics, the rehabilitation of patients undergoing exenteration is of importance. Patient confidence, self-esteem, and their return to normal social life are possible with the use of orbital prostheses.…”