Periorbital Defects Research Articles

Forehead flap periorbital reconstruction.

To evaluate functional and aesthetic results of periorbital defect repair using forehead flaps. Retrospective review of patients who received periorbital defect repair by 3 of us with a paramedian forehead flap alone or in conjunction with other local or regional flaps, bone grafts, or cartilage grafts. Flap survival, functional results, and postoperative complications were determined by physical examination at regular follow-up. Three experienced surgeons other than us quantified aesthetic outcomes using a 10-cm visual analog scale. Eighteen patients underwent periorbital defect repair between August 1, 1989, and December 31, 2000. Defects ranged from 8 to 300 cm(2) (mean, 46.8 cm(2)) in area. The most commonly involved primary structures were the medial canthus, lacrimal drainage system, and medial upper eyelid. The mean improvement on a 10-cm visual analog scale was 1.6 from before resection to after reconstruction and 3.8 from tumor resection to after reconstruction. In all relevant cases, globe coverage and lacrimal drainage system patency were excellent. No patients experienced fistula formation or eyelid retraction. The reliability, versatility, and relative technical simplicity of the forehead flap provide excellent cosmetic and functional results in reconstruction of intermediate-sized periorbital defects, especially those associated with nasal defects.

The role of second-intention healing in periocular reconstruction.

Second-intention healing is a time-honored method of wound management. Its role in periocular reconstruction, however, is currently controversial. The objectives of this thesis are threefold: to evaluate carefully the outcomes in a cohort of patients treated by this technique, to provide a comprehensive review of published reports, and to formulate recommendations and guidelines for appropriate application in selected patients. Eyelid and periorbital defects after excision of periocular tumors were allowed to heal by second intention in 59 patients. The locations of the wounds were the medial canthus (n = 32), lower eyelid (n = 20), upper eyelid, (n = 4), glabella (n = 2), and nasojugal fold (n = 1). Five excised areas involved the eyelid margin, and in three patients the defect included the canalicular system. The size of the defects ranged from 3 x 3 mm to 22 x 27 mm. The average duration of follow-up was 19 months (range, 6 months to 8 years). The functional and cosmetic results were satisfactory in 49 patients (83%). Complications occurred in 10 patients and included ectropion, medial canthal webbing, trichiasis, eyelid notching, and hypertrophic scarring. Only two patients, however, required secondary repair. Healing by second intention is a safe, effective, and inexpensive alternative to surgical reconstruction after tumor excision in selected patients.

The latissimus dorsi free flap in the rehabilitation of enlarged orbital exenteration

The authors present four cases of post-extended orbital carcinomas which requested rehabilitation with a latissimus dorsi myocutaneous free flap (LDFF). The post-extended carcinomas are orbital neoplasms with bone involvement (more than one orbital wall must be involved) and/or large periorbital skin defects. In these cases, local solutions such as skin or muscular pedicle flaps are unavailable. The authors report their approach to this kind of carcinomas. They discuss the place of the LDFF among the other available free flaps as to the pros and cons of this surgical technique.

Orbital Exenteration

Following orbital exenteration, there is a spectrum of immediate and delayed options for orbital reconstruction. Goals of reconstruction after exenteration include detection of recurrent disease, restoration of boundaries between the orbit and surrounding structures, and optimal aesthetics. Local solutions to problems of the exenterated orbit, such as healing by granulation or application of split-thickness skin grafts, are advantageous for detecting recurrent disease. Regional solutions, involving transfer of periorbital tissue into the orbit, may mask recurrent disease and create adjacent deformity; however, these solutions can be used to restore orbital boundaries and shallow the orbital cavity. Distant solutions, such as skin-muscle flaps and free tissue grafts, allow for facial reconstruction in patients with extensive orbital and periorbital defects.

Functional-aesthetic reconstruction of periorbital fractures and defects

Patients with periorbital defects experience social rejection and psychological impairment as a result of their defect. We have developed a procedure to repair the defect which gives aesthetically and functionally satisfactory results. Infraorbital bony reconstruction and reconstruction of the intraorbital anatomical units are performed as primary surgery; supraorbital reconstruction is done secondarily. We make use of implants made of heath-polymerizing prefabricated polymethyl-methacrylate, and have had satisfactory results.