Related Experiment Video
Updated: Aug 12, 2025
08:18
Three-Dimensional Reconstruction of Orbital Fractures
Published on: May 16, 2025
290
Sequential chimeric fibula-gracilis flap to salvage a complex orbitomaxillary defect: A case report
Davide De Cicco1, Gian Battista Bottini2, Alexander Gaggl2
1Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy.
Microsurgery
|January 29, 2023
Summary
This study details using a gracilis muscle free flap to salvage a complex maxillectomy reconstruction. The flap successfully restored function and aesthetics in a challenging case.
Area of Science:
- Plastic Surgery
- Head and Neck Surgery
- Reconstructive Surgery
Background:
- Extended maxillectomies with orbital exenteration present significant reconstructive challenges.
- Achieving both functional and esthetic outcomes requires meticulous planning and versatile reconstructive options.
- Limited single-pedicle solutions exist for extensive defects involving hard and soft tissues.
Observation:
- A 55-year-old male with fibrosarcoma underwent extensive maxillectomy including orbital exenteration.
- Primary reconstruction with fibula and deep circumflex iliac artery flaps failed partially due to intraoperative complications.
- A complex tridimensional defect of the orbit and oral cavity resulted.
Findings:
- An 18 cm gracilis muscle free flap was utilized as a salvage procedure.
- The flap was inset behind transplanted bone to seal both the orbital and oral cavities.
- The salvage surgery resulted in no complications and a stable outcome at 6 months.
Implications:
- The gracilis muscle free flap is a reliable option for salvage reconstruction in complex maxillectomy defects.
- This flap may also be beneficial for primary reconstruction of extensive maxillectomies, potentially combined with other composite free flaps.
- Successful salvage highlights the adaptability of free flap techniques in challenging oncologic resections.
