O149. Iliac crest-tensor fascia lata osteomyocutaneous flap for orbitomaxillary reconstruction

Abstract

The existing methods of the reconstruction fails to simultaneously address two goals of reconstruction of defects after maxillectomy with extensive orbital rim and floor excision: prevent enophtalmos and diplopia and palatal obturation to allow normal speech and satisfactory swallowing. A new method of reconstruction of these defects using iliac crest – tensor facial lata (TFL) flap is proposed. The results of the cadaver dissection, use of the flap in 5 clinical cases and its superiority over the existing methods are described. Initial cadaver dissections were carried out to assess the flap and pedicle characterstics of the iliac crest – TFL flap. This flap was used in 5 cases of cancer of maxilla which necessitated extensive resection of the orbital floor along with the maxillectomy. The flap was raised as a muscle and bone flap in three cases and in two a skin paddle was included. The immediate and delayed outcome at 6 month follow up were analyzed. The functional outcome with regards to the ocular position and function, palatal obturation, speech and swallowing were recorded. The bone viability at 6 months was assessed by CT scan. All the five flaps survived. The pedicle length averaged 7 cm and direct anastamosis was possible to the neck vessels. The delayed outcome assessment showed that the orbital support was excellent with no diplopia in all the cases. The palatal defect could be obturated successfully in all the cases resulting in normal speech and swallowing. The CT scan showed excellent integration in all the cases. Primary closure of the donor site was possible with evidence of no donor site morbidity. Iliac crest – TFL flap is a reliable and safe method of reconstruction of the orbitomaxillary defects. This flap addresses the issues of both orbital support and palatal obturation very well. The flap is associated with minimal morbidity and easy to harvest. С. Айэр, М. Куриакос