Reconstruction Of Orbital Exenteration Defects Research Articles

Reconstruction of Orbital Exenteration Defects with Cross-median Forehead Flaps.

The aim of this study was to examine the role of forehead flaps in the reconstruction of orbital defects after exenteration. Patients undergoing orbital exenteration and reconstruction using median forehead flaps from January 2002 to August 2019 were enrolled in this retrospective study. All the patients were evaluated for wound complications, functional results, and tumor relapse. In total, 105 patients completed the study. Twenty-nine complications in 24 of these patients were assessed. The most common complications were wound dehiscence (11%), partial necrosis of the flap (6%), and bleeding (4%). A major complication occurred in two patients (2%), necessitating surgical correction. Only one patient had a local relapse. Sixty patients received osseointegrated implants, and 58 of them were treated with facial prostheses. The follow-up periods ranged from 6 to 189 months. Thus, forehead flap reconstruction after exenteration is a reliable method with a low complication rate. This technique can be used for primary or secondary reconstruction, and excellent long-term functional results can be achieved. A relapse-oriented follow-up is certainly possible.

Reconstruction of orbital exenteration defects: about 20 cases

The face is social support. Eyes allow the individual to interact with the environment and others. Orbital exenteration defects are the results of extreme disfiguring surgery, leading to functional, aesthetic and psychological sequelae. Reconstruction is essential and must meet several objectives: filling the cavity and closing any communications with the adjacent structures, obtaining rapid healing, allowing for local monitoring and finally enabling patients to reintegrate into society and achieve a satisfactory quality of life. We here present our experience in filling and reconstructing these cavities. Our study involved 20 patients with orbital exenteration defects over a period of 5 years (February 2015-February 2020). We analyzed the epidemiological features, clinical profile, and methods of the reconstruction as well as patients´ outcomes in our hospital. The average age of patients was 58.5 years. Squamous cell carcinoma was the main histological type, followed by basal cell carcinoma. Filling techniques included directed wound healing (7 cases), temporalis fascia flap (2 cases), temporalis muscle flap (10 cases). Methods of reconstruction included directed wound healing (6 cases), full-thickness skin graft (1 case), mediofrontal flap (6 cases; alone or associated with the temporalis muscle), converse scalping flap in three cases. Free latissimus dorsi flap was used in two cases. Thirteen patients showed good outcomes, with good healing after an average follow-up period of 9 months. The most common complication was infection and suture release. Two patients were lost to follow-up. Orbital exenteration defects can be approached in many ways. Temporalis muscle flap has been shown to be a robust and safe choice as well as an excellent filling solution. Prostheses are an aesthetic but expensive solution that should be developed in our hospital.

Social Perception of Reconstruction following Orbital Exenteration

Background:Orbital exenteration, the removal of the entire globe, eyelids, and orbital content, is indicated in extensive neoplastic disease involving the orbital region. Although a functional reconstruction of orbital exenteration defects is mandatory, aesthetic concerns need to be considered. Facial disfigurement following reconstructive surgery often leads to great discomfort and social retirement, which can limit social interaction. The aim of this study was to explore how the society perceives the aspect of patients who underwent orbital exenteration and subsequent reconstruction, comparing two different types of reconstruction: standard anterolateral thigh (ALT) or “sandwich” fascial ALT (SALT) free flap.Methods:An online survey was created based on four questions regarding the perception of reconstruction (discomfort at looking at that patient, perception of unhealthiness, hypothesis of social life impairment, etc); five possible answers were provided, ranging from “completely” to “not at all.” The survey was administered to the general population and to medical students.Results:In total, 255 people participated to the survey (130 medical students and 125 people of the general population); a total of 245 surveys were considered eligible (10 were incomplete and then discharged). Statistical significance was found (P < 0.001) regarding the better overall appearance of the SALT group over the ALT one.Conclusions:After analysis, the surgical outcome after SALT reconstruction has been found to be less disruptive in both groups, due to a reduced scar burden and a more pleasant orbital pocket. Our results encourage more research in the field of postexenteration reconstruction to achieve more aesthetic and social acceptability.

Reconstruction of Orbital Exenteration Defects with Cheek Rotation Flaps: Indications, Technique, Complications, Rehabilitation, and Survival.

The objective of this study was to examine the role of cheek rotation flaps in the reconstruction of orbital defects after exenteration. From January 2000 to August 2018, patients undergoing orbital exenteration and reconstruction with cheek rotation flaps were enrolled in this retrospective study. All patients were evaluated for wound complications, orbital rehabilitation, tumor relapse, and survival. Thirty patients completed the study. Fourteen complications allocated to 11 patients were assessed. The most common complications were seroma (13%), temporary facial nerve weakness (13%), and partial necrosis of the flap (10%). A major complication occurred in a total of two patients (7%), so that surgical correction was necessary. Eleven patients had a relapse; 15 patients died as part of the follow-up. Fifteen patients were treated with facial prostheses. The overall survival rate was 61% after 1 year and 42% after 5 years. Follow-up periods ranged from 6 to 95 months. Cheek rotation flap reconstruction after exenteration is a reliable method with a low rate of major complications. It is indicated when an approach to the parotid gland or the neck region is necessary because of suspected lymph node metastasis and in elderly patients because of their skin's laxity. It can be performed as primary or secondary reconstruction. Good esthetic results can be achieved, especially after endosseous implantation.

Regional Reconstruction of Orbital Exenteration Defects.

Aggressive disease such as invasive fungal infections or malignancies may necessitate orbital exenteration. The defects of orbital exenteration are often complex involving adjacent structures. Rehabilitation of the orbital exenteration defect poses unique challenges to the reconstructive surgeon. Various options have been described ranging from secondary intention to microvascular free tissue reconstruction. Here the authors review local/regional options for reconstruction of orbital exenteration defects.

Naso- or Orbitocutaneous Fistulas after Free Flap Reconstruction of Orbital Exenteration Defects: Retrospective Study, Systematic Review, and Meta-Analysis.

Objective Naso- or orbitocutaneous fistula (NOF) is a challenging complication of orbital exenteration, and it often requires surgical repair. We sought to identify the incidence and risk factors for NOF after orbital exenteration. Study Design Retrospective chart review, systematic review, meta-analysis. Setting Tertiary care center. Participants Patients undergoing free flap reconstruction following orbital exenteration. Records were reviewed for clinicopathologic data, operative details, and outcomes. Main Outcome Measures Univariate analysis was used to assess risk factors for incidence of postoperative NOF. PubMed and Cochrane databases were searched for published reports on NOF after orbital exenteration. Rates of fistula and odds ratios for predictive factors were compared in a meta-analysis. Results Total 7 of 77 patients (9.1%) developed NOF; fistula formation was associated with ethmoid sinus involvement ( p < 0.05) and minor wound break down ( p < 0.05). On meta-analysis, pooled rates of fistula formation were 5.8% for free flap patients and 12.5% for patients receiving no reconstruction. Conclusion Immediate postoperative wound complications and medial orbital wall resection increased the risk for NOF. On review and meta-analysis, reconstruction of orbital exenteration defects decreased the risk for fistula formation, but published series did not demonstrate a significant decrease in risk with free flaps compared with other methods of reconstruction.

MRI findings of myocutaneous and fasciocutaneous flaps used for reconstruction of orbital exenteration defects.

To facilitate detection of tumor recurrence, the authors reviewed the MRI characteristics of myocutaneous and fasciocutaneous free flaps following orbital exenteration for treatment of orbital or maxillofacial tumors. The authors retrospectively reviewed the MRI characteristics, including T1 and T2 signal intensity, and enhancement pattern of 28 such flaps. The study included 17 myocutaneous flaps and 11 fasciocutaneous flaps placed in 28 patients. For 23 flaps, additional imaging was performed after baseline imaging (range, 2-65 months after surgery). On precontrast T1 imaging, 15 of 17 myocutaneous flaps demonstrated a striated appearance similar to that of native muscle. Twenty-six of the 28 flaps in the series were T2 hyperintense. On baseline imaging, 26 flaps showed linear (n = 5), patchy (n = 10), or homogeneous (n = 11) enhancement. No flaps demonstrated mass-like enhancement. Five fasciocutaneous and 5 myocutaneous flaps showed decreased enhancement on follow-up imaging, while 4 myocutaneous flaps showed increased enhancement. Fourteen patients received postoperative radiation, 4 of which demonstrated increased enhancement, which subsequently decreased in 3 flaps. Fourteen of 23 followed flaps became smaller over time. On MRI, both myocutaneous and fasciocutaneous flaps placed after orbital exenteration generally demonstrate persistent non-mass-like enhancement and T2 hyperintensity, and both types of flaps may become smaller over time. Head and neck radiologists, ophthalmologic and plastic surgeons, and oncologists should be aware of the range of imaging features of these flaps to avoid misinterpreting the postoperative appearance as tumor recurrence.

OP034: Orbital exenteration defects with maxillectomy: Options and outcome

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.

Reconstruction of orbital exenteration defects by primary closure using cheek advancement

IntroductionOrbital exenteration is a highly disfiguring procedure which, although providing local control of invasive orbital malignancy also results in marked visual, psychological and social disability. We present three consecutive total...

Reconstruction of Large Orbital Exenteration Defects after Resection of Periorbital Tumors of Advanced Stage

Orbital exenteration is a devastating procedure because of the social impact and psychological stress put upon the patient. Besides cancer ablative surgery, reconstruction after removal of the tumor constitutes a major problem and the final aesthetic result is quite important. Both obliteration of the orbital cavity and continuation of the epithelial lining are required. Free rectus abdominis muscle and musculocutaneous flaps are versatile flaps which both enable filling the cavity and reconstituting the skin defect with a cutaneous portion or with a skin graft. Both free rectus abdominis muscle and musculocutaneous flaps were used for reconstruction of orbital exenteration defects in 19 patients. All suffered partial maxillectomy as well. The flaps provided satisfactory aesthetic results in all patients.