The Role of Perforator Island Flaps for the Reconstruction of Midfacial and Periorbital Large and Deep Defects

To describe a single-hospital experience with the reconstruction of broad and deep periorbital defects with perforator island flaps (PIFs).

Twenty cases of reconstruction of complex defects in the periocular region using PIF were selected and revised. All cases were performed in the university hospital of the University of São Paulo, Ribeirão Preto, Brazil, from September 2018 to July 2024. Data collected included intraoperative and postoperative photographic documentation, lesions diagnoses, defect sizes and locations, PIF sizes and axes of mobilization, postoperative follow-up duration, and complications.

All patients underwent periorbital reconstruction with PIF after tumor resection. In 7 cases, the defects involved the lower lid cheek junction, and in 10 cases, they extended into the medial canthus, including 3 cases of orbital exenteration. The lateral periorbital region was affected in 2 patients. The mobilization of the flaps was from the lower cheek toward the lower eyelid in 7 patients, toward the medial canthal area in 10 patients, and horizontally to cover defects in the medial and temporal regions in 2 cases. The size of the resultant defect averaged 7.9 cm 2 . The mean follow-up time was 40 months. The flap remained viable in 100% of cases.

PIFs are a versatile option for reconstructing large periorbital defects and extended exenterations, and this technique should be included in the repertoire of procedures for managing midfacial tumors.