Optimizing Reconstruction with Periorbital Transplantation: Clinical Indications and Anatomic Considerations

Area of Science:

• Plastic Surgery
• Ophthalmology
• Transplantation Surgery

Background:

• Complex periorbital reconstruction presents unique challenges due to individualized patient needs.
• Effective reconstruction requires careful consideration of functional and aesthetic goals.

Purpose of the Study:

• To explore the indications for periorbital transplantation.
• To assess the anatomic feasibility of periorbital allotransplantation.
• To review institutional data on facial injuries for transplant suitability.

Main Methods:

• Retrospective chart review of patients with periorbital defects at a major trauma center.
• Evaluation of patient history, defect characteristics, visual acuity, and periorbital function.
• Cadaveric allograft design and harvest to determine anatomic feasibility for specific defects.

Main Results:

• Seven candidates with periorbital defects from diverse etiologies (trauma, burn, animal attack, tumor) were identified.
• Proposed transplants included isolated periorbital and total face allotransplants.
• Successful allograft recovery was achieved for 4 periorbital subunits and 1 full face, with dual vascular supply in most periorbital subunits.

Conclusions:

• Periorbital transplantation, including isolated structures or full face, is technically feasible.
• Key goals include restoring eye protection, preventing vision loss, and optimizing aesthetics.
• Candidate selection and allograft design depend on defect type, function, ophthalmologic evaluation, and etiology.