Microvascular approach to function and appearance of large orbital maxillary defects.
Forty-three patients with major three-dimensional orbitomaxillary defects underwent 48 free-tissue transfers for defects arising from resection of a neoplasm or trauma. Defects were complex, involving the malar skin, mandible, lateral nasal wall, orbit, palate, and brain. A three-dimensional approach attempting to recreate the midface by folding the flaps was the usual method, with subsequent revisions if necessary. Ten patients had simultaneous free bone grafts and 6 had vascularized bone grafts. There were three flap failures and four perioperative deaths. Excluding the 4 deaths, the results were assessed as excellent in 25 patients, good in 12, and poor in 2. Free-tissue transfer is a reliable method of providing enough tissue at one initial operation to satisfy complex three-dimensional defects of the orbitomaxillary region. Followed by minor revision, it provides a means of restoring function and appearance without multiple staged procedures with a high risk of failure.
Coleman
J J
JJ
Emory University School of Medicine, Crawford W. Long Hospital, Atlanta, Georgia.
D016025:Bone Transplantation; D001842:Bone and Bones / Q000098:blood supply; D003528:Carcinoma, Adenoid Cystic / Q000534:rehabilitation / Q000601:surgery; D002280:Basal Cell Carcinoma / Q000534:rehabilitation / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000534:rehabilitation / Q000601:surgery; D005145:Face / Q000098:blood supply / Q000601:surgery; D005147:Facial Bones / Q000098:blood supply / Q000601:surgery; D005152:Facial Muscles / Q000098:blood supply / Q000601:surgery; D005260:Female; D006258:Head and Neck Neoplasms / Q000534:rehabilitation* / Q000601:surgery; D006801:Humans; D008297:Male; D008446:Maxillofacial Injuries / Q000534:rehabilitation* / Q000601:surgery; D012509:Sarcoma / Q000534:rehabilitation / Q000601:surgery; D016038:Skin Transplantation; D013518:Surgery, Plastic / Q000379:methods*; D013524:Surgical Flaps