OP034: Orbital exenteration defects with maxillectomy: Options and outcome

Abstract

Purpose The present study attempts to review the options and outcomes of orbital exenteration defect reconstruction with free flaps. We also present the risk categorization and patient selection criteria used at our institute. Material and methods A study of 23 consecutive patients who underwent maxillectomy/ Craniofacial resection with orbital exenteration and free flap reconstruction. The study period was between 2004 and 2011. Results There were 17 male and 6 females in the study. The flaps used were free rectus abdominis myocutaneous flap ( n = 10), anterolateral thigh flap ( n = 4); free fibula flap ( n = 3), deep circumflex iliac flap with internal oblique muscle ( n = 5). Free tensor fascia lata with iliac crest and internal oblique muscle was used in five patients to get a composite eye socket reconstruction with ocular prosthesis. One patient had a simultaneous double free flap reconstruction with a combination of free fibula flap and free radial forearm flap. This patient died in the immediate postoperative period due to systemic complications. Excluding this patient, the flap success rate w as 95.5% (21/22). Eight patients are alive and disease free after a mean follow up of 30.5 months (range: 6–76 months). We present an algorithm for the choice of reconstructive approach. In high risk, old patients with co-morbidities, regional flaps like Temporalis with spectacle prosthesis/Obturator; In intermediate risk patients we suggest, soft tissue flaps with bulk (rectus abdominis) and spectacle prosthesis and in young low risk individuals, a composite socket reconstruction with the free tensor fascia lata with iliac crest and internal oblique muscle is an ideal option. Conclusions Free microvascular tissue transfer has improved the results of reconstruction of orbital exenteration defects. Free rectus abdominis flap remains the commonest choice. Free fibula flap is useful in cases with associated bony defects of maxillectomy. When a composite socket reconstruction is to be achieved, the innovative free tensor fascia lata with iliac crest and internal oblique muscle is an excellent option but needs two simultaneous pair of vessel anastamosis.