Reconstruction of Anophthalmic Orbits and Contracted Eye Sockets With Microvascular Radial Forearm Free Flaps

Abstract

To reconstruct the anophthalmic orbit using a microvascular radial forearm free flap in patients with significant volume loss and socket contracture after exenteration or enucleation. This is a retrospective observational case series of 22 subjects with acquired anophthalmic orbits after tumor resection or trauma: 14 patients with retinoblastoma who underwent enucleation followed by adjuvant radiation therapy and 8 patients with malignant orbital tumors or orbital trauma who underwent exenteration of the orbit. All patients had large orbital defects or severely contracted eye sockets. Patients underwent orbital reconstruction with implantation of a microvascular radial forearm free flap with or without placement of a hydroxyapatite sphere or conical implant. All patients were followed for 6 months to 6 years. Long-term improvement of socket contracture, prosthesis fit, and cosmetic appearance of patients was observed. The prosthetic eyes were well fitted in the eye socket using this technique. Our results demonstrate successful functional and clinical outcomes for treatment of severe anophthalmic orbital syndrome using microvascular radial forearm free flaps. However, further prospective, long-term studies are recommended.