Objective: The present study attempts to review the options and outcomes of orbital exenteration
defect reconstruction with free flaps.
Design: Retrospective case series.
Methods: A study of 20 consecutive patients who underwent maxillectomy/craniofacial resection,
orbital exenteration, and free-flap reconstruction. The study period was between 2004
and 2010.
Results: There were 14 males and 6 females in the study. The flaps used were free rectus abdominis
myocutaneous flap (n = 10), anterolateral thigh flap (n = 4), free fibula flap (n
= 3), and deep circumflex iliac flap with internal oblique muscle (n = 1). Free tensor
fascia lata with iliac crest and internal oblique muscle was used in one patient to
get a composite eye socket reconstruction with ocular prosthesis. One patient had
a simultaneous double free-flap reconstruction with a combination of free fibula flap
and free radial forearm flap. This patient died in the immediate postoperative period
due to systemic complications. Excluding this patient, the flap success rate was 94.7%
(18/19). Eight patients are alive and disease free after a mean follow-up of 27.5
months (range: 6 to 64 months).
Conclusions: Free microvascular tissue transfer has improved the results of reconstruction of
orbital exenteration defects. Free rectus abdominis flap remains the most common choice.
Free fibula flap is useful in cases with associated bony defects of maxillectomy.
When a composite socket reconstruction is to be achieved, the innovative free tensor
fascia lata with iliac crest and internal oblique muscle is an excellent option but
needs two simultaneous pairs of vessel anastomosis.
