Osseous free flaps for orbit and midface reconstruction

Area of Science:

• Oral and Maxillofacial Surgery
• Plastic and Reconstructive Surgery
• Oncology

Background:

• Reconstruction of the orbit and midface often presents challenges, especially in patients with prior radiotherapy.
• Vascularized osseous free flaps offer a viable solution for complex bony defects in these areas.
• Understanding the suitability of different flap types for specific anatomical locations is crucial for successful outcomes.

Purpose of the Study:

• To evaluate the efficacy and outcomes of osseous free flap reconstruction for orbit and midface defects.
• To compare the suitability of various osseous free flap donor sites for different reconstructive needs.
• To assess the impact of prior radiotherapy on the success of these reconstructions.

Main Methods:

• Retrospective analysis of 10 patients undergoing orbit and/or midface reconstruction using osseous free flaps.
• Flaps utilized included fibula, radial forearm, scapula, and split iliac crest.
• Patient data included defect location, prior radiotherapy, flap type, complications, and functional/aesthetic outcomes.

Main Results:

• Overall good or fair results were achieved in 90% of patients.
• Radial forearm flaps were optimal for smaller, orbit-only reconstructions.
• Fibula, iliac crest, and scapula flaps were best for larger, maxilla-involved defects. One flap loss occurred (10%), with 20% overall complications.

Conclusions:

• Osseous free flaps are a reliable option for orbit and midface reconstruction, especially when bony support is required post-irradiation.
• Donor site selection should be tailored to the size and location of the bony defect.
• Successful osseointegrated dental implants were also noted in select cases.