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
References
[1]
Y. G. Song, G. Z. Chen, and Y. L. Song, “The free thigh flap: a new free flap concept based on the septocutaneous artery,” British Journal of Plastic Surgery, vol. 37, no. 2, pp. 149–159, 1984.
[2]
P. Yu, “Characteristics of the anterolateral thigh flap in a western population and its application in head and neck reconstruction,” Head and Neck, vol. 26, no. 9, pp. 759–769, 2004.
[3]
F. C. Wei, V. Jain, N. Celik, H. C. Chen, D. C. C. Chuang, and C. H. Lin, “Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flaps,” Plastic and Reconstructive Surgery, vol. 109, no. 7, pp. 2219–2226, 2002.
[4]
K. Malhotra, T. S. Lian, and V. Chakradeo, “Vascular anatomy of anterolateral thigh flap,” Laryngoscope, vol. 118, no. 4, pp. 589–592, 2008.
[5]
E. A. Lueg, “The anterolateral thigh flap: radial forearm's “big brother” for extensive soft tissue head and neck defects,” Archives of Otolaryngology, vol. 130, no. 7, pp. 813–818, 2004.
[6]
S. M. Weber, J. H. Kim, and M. K. Wax, “Role of free tissue transfer in skull base reconstruction,” Otolaryngology, vol. 136, no. 6, pp. 914–919, 2007.
[7]
J. M. Rodríguez-Vegas, P. A. ángel, and P. R. Manuela, “Refining the anterolateral thigh free flap in complex orbitomaxillary reconstructions,” Plastic and Reconstructive Surgery, vol. 121, no. 2, pp. 481–486, 2008.
[8]
Y. R. Kuo, M. C. Yeh, H. S. Shih et al., “Versatility of the anterolateral thigh flap with vascularized fascia lata for reconstruction of complex soft-tissue defects: clinical experience and functional assessment of the donor site,” Plastic and Reconstructive Surgery, vol. 124, no. 1, pp. 171–180, 2009.
[9]
S. Yildirim, G. Avci, and T. Ak？z, “Soft-tissue reconstruction using a free anterolateral thigh flap: experience with 28 patients,” Annals of Plastic Surgery, vol. 51, no. 1, pp. 37–44, 2003.
[10]
I. Koshima, H. Fukuda, H. Yamamoto et al., “Free anterolateral thigh flaps for reconstruction of head and neck defects,” Plastic and Reconstructive Surgery, vol. 92, no. 3, pp. 421–430, 1993.
[11]
N. Kimura, K. Satoh, T. Hasumi, and T. Ostuka, “Clinical application of the free thin anterolateral thigh flap in 31 consecutive patients,” Plastic and Reconstructive Surgery, vol. 108, no. 5, pp. 1197–1208, 2001.
[12]
B. Strauch and H.-L. Yu, Atlas of Microvascular Surgery: Anatomy and Operative Approaches, Thieme Medical Publishers, New York, NY, USA, 2nd edition, 2006.
[13]
T. O. Acartürk, “Femur-vastus intermedius-anterolateral thigh osteomyocutaneous composite chimeric free flap: a new free flap for the reconstruction of complex wounds,” Journal of Reconstructive Microsurgery, vol. 27, no. 3, pp. 187–193, 2011.
[14]
C.-H. Wong and F.-C. Wei, “Anterolateral thigh flap,” Head and Neck, vol. 32, no. 4, pp. 529–540, 2010.
