[Orbito-facial reconstruction after extensive anterior skull base, head and neck resection using a rectus abdominis...

In response to the recent advances in aggressive excision of skull base and head and neck malignancies, a more sophisticated method primary reconstruction has been developed using a craniofacial techniques for preservation of postoperative quality of life. We have developed an inferior pedicled rectus abdominis musculocutaneous flap with rib cartilages for reconstruction of the orbito-facial region. The advantages of this flap are as follows; 1) Simultaneous flap elevation in a supine position is possible, 2) Easy, versatile and reliable flap adjustment can be made for complicated space defect, 3) Curvature of the ipsilateral rib cartilages is suitable for inferior orbital rim, 4) Lower risk of pleura laceration as compared with a superior pedicled flap. In the past 5 years, the composite free flaps have been applied for 3 cases of hemi orbito-facial defect, with better results than in previous cases. Our technique for the flap application in a representative case is illustrated.