Orbital Exenteration Defect Reconstruction: Options and Outcome

Objective: The present study attempts to review the options and outcomes of orbital exenteration defect reconstruction with free flaps.

Design: Retrospective case series.

Methods: A study of 20 consecutive patients who underwent maxillectomy/craniofacial resection, orbital exenteration, and free-flap reconstruction. The study period was between 2004 and 2010.

Results: There were 14 males 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), and deep circumflex iliac flap with internal oblique muscle (n = 1). Free tensor fascia lata with iliac crest and internal oblique muscle was used in one patient 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 was 94.7% (18/19). Eight patients are alive and disease free after a mean follow-up of 27.5 months (range: 6 to 64 months).

Conclusions: Free microvascular tissue transfer has improved the results of reconstruction of orbital exenteration defects. Free rectus abdominis flap remains the most common 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 pairs of vessel anastomosis.