%0 Journal Article
%T Use of the Anterolateral Thigh in Cranio-Orbitofacial Reconstruction
%A William J. Parkes
%A Howard Krein
%A Ryan Heffelfinger
%A Joseph Curry
%J Plastic Surgery International
%D 2011
%I Hindawi Publishing Corporation
%R 10.1155/2011/941742
%X Objective. To detail the clinical outcomes of a series of patients having undergone free flap reconstruction of the orbit and periorbita and highlight the anterolateral thigh (ALT) as a workhorse for addressing defects in this region. Methods. A review of 47 patients who underwent free flap reconstruction for orbital or periorbital defects between September 2006 and May 2011 was performed. Data reviewed included demographics, defect characteristics, free flap used, additional reconstructive techniques employed, length of stay, complications, and follow-up. The ALT subset of the case series was the focus of the data reviewed for this paper. Selected cases were described to highlight some of the advantages of employing the ALT for cranio-orbitofacial reconstruction. Results. 51 free flaps in 47 patients were reviewed. 38 cases required orbital exenteration. The ALT was used in 33 patients. Complications included 1 hematoma, 2 wound infections, 3 CSF leaks, and 3 flap failures. Conclusions. Free tissue transfer allows for the safe and effective reconstruction of complex defects of the orbit and periorbital structures. Reconstructive choice is dependent upon the extent of soft tissue loss, midfacial bone loss, and skullbase involvement. The ALT provides a versatile option to reconstruct the many cranio-orbitofacial defects encountered. 1. Introduction Extirpative surgery involving the orbit and periorbita often results in a complex defect involving multiple midfacial subsites. Depending upon the extent of resection, the reconstructive surgeon may need to address any combination of the following: periorbital skin (forehead, nose, and midface), orbital soft tissue, supra orbital or midface bone, paranasal sinuses, and anterior skull base. A multitude of reconstructive options are available including skin grafting and regional flaps, such as the temporalis muscle or temporoparietal fascia. Yet, in some cases the volume of soft tissue loss or complexity of the defect may require the versatility afforded by free tissue transfer for optimal reconstruction. A variety of free flaps may be employed to this end, including the anterolateral thigh (ALT), radial forearm (RF), fibula, and latissimus dorsi. At our institution, we favor the use of the ALT. The ALT functions to allow a variety of soft tissue configurations very useful to periorbital reconstruction and is the subject of this work. First described by Song et al. [1] in 1984, the ALT has become a workhorse in head and neck reconstruction, allowing for a two-team approach and offering versatility, ample pedicle
%U http://www.hindawi.com/journals/psi/2011/941742/