Microvascular reconstruction of the orbit and adjacent regions: A case series

Abstract

Objective: The purpose of this paper is to present our clinical experience with microvascular free flaps for reconstructing defects of the orbit and adjacent regions. Patients and methods: We reviewed retrospectively our oncologic patients treated from 2011 to 2019. Results: Sixteen patients were treated with 21 flaps. Later, five of these patients required ten additional “salvage” flaps to obliterate fistulas or seal the skull base. A stable healed wound was achieved in all cases, eventually. Conclusions: Based on our experience, a timely referral to a head and neck unit is critical to try and avoid the recurring tragedy of patients undergoing multiple insufficient resections and eventually dying, despite extensive surgery and radiotherapy at an advanced cancer stage. Bone free flaps are safer than bone grafts or implants when the receiving area has poor vascularity due to previous interventions or when adjuvant radiotherapy is required. In addition, the vascularised medial femur condylar flap is well suited for reconstructing small bone defects of functional or aesthetic significance.

Keywords

• Orbital exenteration
• Maxillectomy
• Head and neck cancer
• Microvascular free flaps
• Head and neck reconstruction
• Medial femoral condylar flap