Reconstruction of Extensive Orbital Exenteration Defects Using an Anterolateral Thigh/Vastus Lateralis Chimeric Flap

Area of Science:

• Plastic Surgery
• Ophthalmology
• Oncology

Background:

• Orbital exenteration is a radical surgical procedure for advanced orbital malignancies.
• Extensive defects, particularly those involving paranasal sinuses, pose significant reconstructive challenges.
• 3-dimensional reconstruction requires specialized techniques to restore form and function.

Observation:

• This study evaluated the use of anterolateral thigh vastus lateralis (ALT/VL) chimeric free flaps in 4 patients.
• The ALT component was utilized for cutaneous resurfacing, while the VL component addressed cavitary defects.
• Flaps were based on a common descending pedicle, with individual component dissection and neck vessel anastomosis.

Findings:

• The ALT/VL chimeric flap successfully reconstructed extensive 3-dimensional orbital defects with sinus involvement.
• Simultaneous reconstruction of both surface and cavitary defects was achieved.
• No flap-related complications were observed during an average follow-up of 17 months.

Implications:

• The ALT/VL chimeric free flap offers a versatile solution for complex orbital reconstructions.
• This technique facilitates the simultaneous management of distinct spatial and volumetric defects.
• It represents a valuable option for improving outcomes in patients undergoing orbital exenteration for neglected tumors.