Reconstruction of the anophthalmic orbit by orbital osteotomy and free flap transfer

It is a challenging problem for the plastic surgeon to perform adequate reconstruction of the postenucleation and radiated orbit of patient with retinoblastoma. Rebuilding of the orbital structure, reconstruction of the eye socket, and restoration of periorbital volume are required in this kind of orbital reconstruction. In this study, we reviewed 12 patients with hypoplastic orbital deformities who underwent orbital osteotomy and free flap transfer. Reconstruction of the orbital cavity was achieved using "C" osteotomy of the lateral portion of the orbit in mild and moderate cases or transverse "U" osteotomy of the lateral wall, roof, and floor by an intracranial approach in a portion of severe cases. Socket reconstruction and periorbital volume restoration was achieved using dorsalis pedis free flap transfer by microsurgery. What we concluded from our experience was that the combination of orbital osteotomy and free flap transfer could meet the multirequirements for anophthalmic orbital reconstruction, including both orbital bony enlargement and soft tissue restoration.