Strategies for the Reconstruction of Periorbital and Temporal Tissue

Introduction/Aim: Different reconstruction strategies for periorbital bone and the surrounding soft tissue are controversial. In addition to regional flaps, autogenous nonvascular tissue transfer and alloplastic replacement are commonly used. Especially following avascular reconstruction of the soft tissue, long-term success is limited by the changes of dimension, volume, and surface of the transplanted soft tissue. Thus, the aim of this project was to evaluate the suitability of microvascular reanastomosed free flaps for periorbital reconstruction.

Material and Method: Between April 2005 and July 2006 a total of 99 patients (ages 26 to 81) underwent therapy with microvascular reanastomosed free flaps (n = 31 females, n = 68 males; 13 patients underwent soft tissue augmentation of the face [forearm flap n = 10 (76.9%); scapula flap n = 3 (23.1%)]. Five patients underwent periorbital soft tissues augmentation, 3 patients temporal soft tissues augmentation. All flaps were anastomosed to a branch of the external carotid artery and the jugular vein respectively. Arterial sutures were performed with 8/0 materia l, venous sutures were performed with 9/0 material. The success of the therapy was evaluated by duplex ultrasound of the anastomosed vessels, ultrasound with respect to soft tissue thickness, comparison of the pre- and postoperative photo records, duration of hospitalization, and morbidity of the donor region.

Results: In every case unlimited patency of the anastomosis was proven by duplex ultrasound. After resolution of swelling the soft tissue thickness corresponded to the opposite side. The comparison of the pre- and postoperative photo documentation showed a clear profile harmonization of the face. After resolution of swelling no further atrophy of the soft tissue thickness was detected. The average duration of hospitalization was 12.5 ± 3.5 days. Initial disabilities of the donor region were tolerated in every case.

Conclusion: The illustrated concept offers a stable reconstruction of the hypodermic face tissue with moderate surgical complexity, moderate duration of hospitalization, and low morbidity rate of the donor region. Thus, microvascular reanastomosed free flaps contribute valuable additional strategies for the reconstruction of periorbital and temporal tissue.