Complete orbit and forehead reconstruction using a free latissimus dorsi flap and MEDPOR implants.
BACKGROUND
Reconstruction of enormous composite defects of the face in the presence of meningitis is a difficult problem. We present a case of a 29-year-old man with a huge, posttraumatic bone and soft tissue defect of the upper half of the left side of the face (orbit-zygoma-frontal-partial temporal bones), frontal lobe of the brain, and enucleated eye with intact facial skin.


METHODS
An initial reconstruction using cement was complicated by multiple episodes of meningitis. In a multiple-stage procedure, we used a free latissimus dorsi muscle flap to re-construct the soft tissue defect and control the infection, a complete left orbit and frontal MEDPOR implant for the bone defect, and also an orbital sphere MEDPOR implant for the eyeball.


RESULTS
In a 2-year follow-up, no infection was observed, and the cosmetic result is satisfactory.


CONCLUSIONS
The combination of free flap and MEDPOR implants demonstrates an alternative method for reconstruction of complicated facial defects.
Antonopoulos
Dimitrios
D
Plastic and Reconstructive Surgery Department, Aghios Andreas General Hospital of Patras, 74 Fanariou Street, 26226, Patras, Greece.
Tsiliboti
Dimitra
D
Skarpetas
Dimitrios
D
Masmanidis
Aris
A
D000328:Adult; D003646:Debridement; D005137:Eye, Artificial; D005147:Facial Bones / Q000293:injuries / Q000473:pathology* / Q000601:surgery; D005500:Follow-Up Studies; D005546:Forehead / Q000601:surgery*; D006801:Humans; D008297:Male; D008581:Meningitis / Q000150:complications*; D009915:Orbit / Q000601:surgery*; D019736:Prostheses and Implants; D019651:Plastic Surgery Procedures / Q000379:methods*; D016038:Skin Transplantation; D013524:Surgical Flaps