Complete orbit and forehead reconstruction using a free latissimus dorsi flap and MEDPOR implants

Abstract

Reconstruction of enormous composite defects of the face in the presence of meningitis is a difficult problem. We present a case of a 29-year-old man with a huge, posttraumatic bone and soft tissue defect of the upper half of the left side of the face (orbit-zygoma-frontal-partial temporal bones), frontal lobe of the brain, and enucleated eye with intact facial skin. An initial reconstruction using cement was complicated by multiple episodes of meningitis. In a multiple-stage procedure, we used a free latissimus dorsi muscle flap to re-construct the soft tissue defect and control the infection, a complete left orbit and frontal MEDPOR implant for the bone defect, and also an orbital sphere MEDPOR implant for the eyeball. In a 2-year follow-up, no infection was observed, and the cosmetic result is satisfactory. The combination of free flap and MEDPOR implants demonstrates an alternative method for reconstruction of complicated facial defects.