Free Tissue Transfer for Cranio‐orbitofacial Defects

Abstract

Objective: 1) Examine the outcomes and complications from a single institution experience with free tissue transfer for craniofacial defects involving the orbit. 2) Discuss an algorithm for free flap reconstruction of the orbit and peri-orbital structures. Method: A review of 42 patients who underwent free flap reconstruction for orbital or peri-orbital defects between September 2006 and January 2011 was performed at a tertiary care facility. Data reviewed included demographics, defect characteristics, free flap used, additional reconstructive techniques employed, length of stay, complications, and follow-up. Results: Forty-four cases were identified; thirty-five required orbital exenteration. Periorbital defects included those resulting from significant soft tissue or bony removal from the midface, scalp, or skullbase. We present an algorithm for management of such defects. Free flaps used included anterolateral thigh (31), radial forearm (10), latissimus (2), and rectus abdominus (1). Additional reconstructive techniques were performed concurrently in 23 cases, and 4 patients required revision procedures. Fifteen (36%) patients experienced a complication with flap loss occurring in 2 (4.8%). Mean hospital stay and duration of follow-up were 9.9 days and 13 months, respectively. Conclusion: Free tissue transfer allows for the safe and effective reconstruction of complex defects of the orbit and periorbital structures. Reconstructive choice is dependent upon the extent of soft tissue loss, midfacial bone loss, and skullbase involvement. The anterolateral thigh provides a versatile option to reconstruct the many cranio-orbitofacial defects encountered.