Author(s)
Keven S.Y. Ji, MD MHS
Skylar Trott, MD
John Ng, MD
Davin Ashraf, MD
Sara Yang, MD
Mark K. Wax, MD
Affiliation(s)
Oregon Health and Science University;
Abstract:
Educational Objective: At the conclusion of this presentation, the participants should be able to discuss the use of osteocutaneous radial forearm free flap reconstruction to repair large bony orbital defects.
Objectives: Defects of the orbital floor and rim are often caused by trauma or malignancy. Rarely is composite free tissue transfer required for limited traumatic floor and rim defects. When the defect is extensive, composite tissue is required. We present a case series utilizing an osteocutaneous radial forearm free flap (OCRFFF) to reconstruct orbital rim defects.
Study Design: Case series.
Methods: Electronic medical record review.
Results: Patient 1: A 24 year old female sustained a significant right orbital floor and inferior rim defect from a motor vehicle accident. Patient had undergone multiple previous reconstructive procedures, but continued suffering from recurrent maxillary sinusitis, hypoglobus, and orbitomaxillary fistula. An OCRFFF was chosen to utilize the radial bone to repair the orbital rim defect and fasciocutaneous component to obliterate the fistula and restore orbital volume. Bone flap was secured onto the zygoma using a lag screw. The flap was deepithelialized and used to obliterate the fistula tract and support the orbital contents. Flap healed without complications. Patient 2: A 70 year old male with recurrent squamous cell carcinoma involving the left nasal sidewall underwent resection with removal of the left nasal bone and medial orbital wall. An OCRFFF was chosen to reconstruct the orbital rim and medial wall defect. Bone was secured with midface plates. Skin paddle was used to reconstruct the internal nasal lining. Flap healed without complications.
Conclusions: An OCRFFF can provide vascularized bone to reconstruct the orbital rim defect and soft tissue to help obliterate dead space or reconstruct the internal nasal lining.