Microvascular approach to function and appearance of large orbital maxillary defects

Area of Science:

• Reconstructive surgery
• Oral and maxillofacial surgery
• Plastic surgery

Background:

• Major three-dimensional orbitomaxillary defects often result from neoplasm resection or trauma.
• These complex defects can involve extensive areas including the malar skin, mandible, lateral nasal wall, orbit, palate, and brain.

Purpose of the Study:

• To evaluate the efficacy of free-tissue transfer in reconstructing complex three-dimensional orbitomaxillary defects.
• To assess the functional and aesthetic outcomes of this reconstructive approach.

Main Methods:

• Forty-three patients with major three-dimensional orbitomaxillary defects underwent 48 free-tissue transfers.
• A three-dimensional reconstructive approach, often involving flap folding, was employed.
• Ten patients received simultaneous free bone grafts, and six had vascularized bone grafts.

Main Results:

• Excluding perioperative deaths, outcomes were excellent in 25 patients, good in 12, and poor in 2.
• Three flap failures and four perioperative deaths occurred.
• The procedure successfully addressed complex defects involving multiple facial structures.

Conclusions:

• Free-tissue transfer is a reliable single-stage procedure for complex three-dimensional orbitomaxillary defects.
• This method effectively restores function and appearance, minimizing the need for multiple staged procedures.
• Further minor revisions can optimize results after initial free-tissue transfer reconstruction.