The Orbital Exenteration Defect: Free and Pedicled Flap Reconstructive Options

Introduction: Orbital exenterations cause significant facial disfigurement. They are occasionally required for very advanced malignancies of the head and neck. Reconstruction of these defects is frequently required, and often difficult. The aim of the present study is to describe the Mayo Clinic Arizona experience, a quaternary referral center for head and neck ablation and reconstruction, with the orbitectomy defect.

Methods: A single-center case series was carried out over a 15-year period. Patients met inclusion criteria if they underwent reconstruction of an orbitectomy defect. Data collected included primary tumor site, flap utilized and flap outcome data.

Results: A total of 40 patients met inclusion criteria and were available for analysis. The mean age of the cohort was 64.2 years. The most common tumor site was the skin in 45% (n=18), followed by the ethmoid sinuses in 28% (n=11). A free flap reconstruction was utilized in 85% (n=34) of cases, while a regional flap was used in the remaining. The most common reconstructive option was the anterolateral thigh flap in 63% (n=25), and the remaining flaps utilized were comprised of a wide variety of other options, including radial forearm free flap, submental flap, paramedian forehead flap, temporoparietal fascia flap, rectus abdominis flap, and the medial sural artery perforator flap. Overall flap outcomes were excellent, with only 1 case of complete flap failure and 4 cases of partial flap failure. Additional procedures, such a flap debulking, standing cone removal, or additional facial contouring procedures were required in 48% (n=19) cases.

Conclusions: Various reconstructive options exist for the orbitectomy defect. Data from the present study demonstrates the anterolateral thigh flap to be the workhorse for these defects, but a large variety of other flaps are available to the surgeons armamentarium.