Yang Li1, Hongxin Song, Jingming Liu, Dongmei Li. 1. Beijing, People's Republic of China; and Rochester, N.Y. From the Beijing Tongren Eye Center, Beijing Tongren Hospital, Ophthalmology and Visual Sciences Key Lab, Capital Medical University; and the Center for Visual Science, University of Rochester.
Abstract
BACKGROUND: Severe orbital soft-tissue loss and contracted eye sockets often present in patients who have had enucleation, exenteration, or other ocular diseases. In this article, the authors report a novel contracted eye socket reconstruction technique using lateral upper arm free flaps and review the surgical outcome in patients with severe orbital soft-tissue loss and contracted eye sockets. METHODS: Twenty-four patients with severe orbital soft-tissue loss and contracted eye sockets were included in this study. A free flap from the lateral upper arm of the patient was inserted into the eye socket, with the artery and vein of the flap pedicle attached to the ipsilateral superficial temporal artery and vein, respectively. Eye socket reconstruction was performed 2 weeks after the first operation. Patients were fitted with a piece of prosthesis 3 months later. Most patients needed a second operation for eyelid and eye socket reconstruction, including lower eyelid laxity and retraction correction, medial and lateral canthoplasty, and upper or lower fornix reconstruction. RESULTS: Postoperative improvement in appearance was evaluated, including texture and color of the flaps, sensation and mobility of the forearm and elbow, and visibility of the surgical scar. All 24 patients were followed up for 6 months to 5 years. Donor sites healed with linear scars, and no sensory or movement loss was found in any of the patients. The reconstructed area appeared good, patients were satisfied with recovering results, and the prosthesis fit well. CONCLUSIONS: The skin from the lateral upper arm has consistent blood vessels and suitable thickness to serve as a source for orbital soft-tissue and contracted eye socket reconstruction, with good cosmetic outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
BACKGROUND: Severe orbital soft-tissue loss and contracted eye sockets often present in patients who have had enucleation, exenteration, or other ocular diseases. In this article, the authors report a novel contracted eye socket reconstruction technique using lateral upper arm free flaps and review the surgical outcome in patients with severe orbital soft-tissue loss and contracted eye sockets. METHODS: Twenty-four patients with severe orbital soft-tissue loss and contracted eye sockets were included in this study. A free flap from the lateral upper arm of the patient was inserted into the eye socket, with the artery and vein of the flap pedicle attached to the ipsilateral superficial temporal artery and vein, respectively. Eye socket reconstruction was performed 2 weeks after the first operation. Patients were fitted with a piece of prosthesis 3 months later. Most patients needed a second operation for eyelid and eye socket reconstruction, including lower eyelid laxity and retraction correction, medial and lateral canthoplasty, and upper or lower fornix reconstruction. RESULTS: Postoperative improvement in appearance was evaluated, including texture and color of the flaps, sensation and mobility of the forearm and elbow, and visibility of the surgical scar. All 24 patients were followed up for 6 months to 5 years. Donor sites healed with linear scars, and no sensory or movement loss was found in any of the patients. The reconstructed area appeared good, patients were satisfied with recovering results, and the prosthesis fit well. CONCLUSIONS: The skin from the lateral upper arm has consistent blood vessels and suitable thickness to serve as a source for orbital soft-tissue and contracted eye socket reconstruction, with good cosmetic outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.