Abstract
Objectives To demonstrate the advantages of the thoracodorsal artery scapular tip autogenous
transplant (Tdast) for patients requiring restoration of the orbital aesthetic subunit.
Design Prospective case series.
Setting Tertiary center.
Participants Ten patients (M:F,6:4) with a mean age of 56 years (range, 21 to 78 years) underwent
restoration of the orbital aesthetic subunit and radiation therapy between 2001 and
2008.
Main Outcome Measures The two reconstructive advantages of the thoracodorsal artery system of flaps for
orbital reconstruction are a long pedicle and the suitability of the scapula tip to
meet the three-dimensional requirements of the orbit. Patients were assessed 1 year
or more after treatment for cosmetic outcome, work status, and socialization.
Results Eight of 10 patients benefited from the three-dimensional nature of the scapula tip
bone and 7 of 10 avoided vein grafting. Four of five evaluable patients reported “frequently”
socializing outside their home. Four of five evaluable patients working before undergoing
their treatment were able to return to work posttreatment. Seven of nine patients
with postoperative photographs had minimal or no facial contour deformity.
Conclusions The Tdast can restore orbital contour without osteotomy, and the thoracodorsal artery
system of flaps has a long vascular pedicle that reduces vein grafting. Patients have
an acceptable cosmetic result and return to preoperative work status and socialization.
Keywords
thoracodorsal artery scapular tip autogenous transplant - Tdast - scapula - orbit
- orbital evisceration
