title: Reconstruction of severe anophthalmic orbits and atresic eye sockets after enucleation and irradiation of retinoblastoma by vascular anastomosed free dorsalis pedis flaps' transplantation.
abstract: Retinoblastoma is a common malignant intraocular tumor in childhood, and most patients require enucleation or exenteration even with irradiation. Severe anophthalmic orbits and atresic eye sockets are not rare. We conducted a retrospective study to evaluate the results of surgical management of reconstruction of severe anophthalmic orbits and atresic eye sockets with vascular anastomosed free dorsalis pedis flap transplantation. There were 5 patients (5 eyes) who underwent reconstructive surgery of severe anophthalmic orbits and atresic eye sockets after enucleation and irradiation of retinoblastoma in our hospital during the 3 years. All patients had enucleation and irradiation immediately after the retinoblastoma was diagnosed and had never worn artificial eyes because of the atresic eye sockets. Vascular anastomosed free dorsalis pedis flaps, whose dimensions were typically 6.5 × 5.5 cm(2), were transplanted to reconstruct the severe anophthalmic orbits and atresic eye sockets. The donor sites were covered by free abdominal skin flaps. All the vascular anastomosed free dorsalis pedis flaps were valid after more than 6 months of follow-up. And then all the 5 patients underwent secondary autogenous dermal fat implantation to augment the supraorbital area depression. After the 2-stage reconstruction surgery, the dimensions of the eye sockets were adequate, and all patients were able to wear their prosthesis and had a satisfactory cosmetic result. Implantation of alloplastic materials is not recommended because of insufficient blood supply of the irradiated orbital area.
authors.affiliation: Department of Ophthalmology, Shanghai Ninth People's Hospital affiliated to Shanghai Jiaotong University, School of Medicine, Shanghai, PR China.
authors.forename: Xiaoping
authors.initials: X
authors.lastname: Bi
authors.forename: Xianqun
authors.initials: X
authors.lastname: Fan
authors.forename: Huifang
authors.initials: H
authors.lastname: Zhou
authors.forename: Wodong
authors.initials: W
authors.lastname: Shi
authors.forename: Caiwen
authors.initials: C
authors.lastname: Xiao
authors.forename: Min
authors.initials: M
authors.lastname: Lin
authors.forename: Zhenkang
authors.initials: Z
authors.lastname: Li
mesh_terms: D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical; D000853:Anophthalmos / Q000601:surgery*; D003286:Contracture / Q000601:surgery; D015353:Eye Enucleation; D005260:Female; D005528:Foot / Q000098:blood supply*; D006801:Humans; D008297:Male; D020273:Orbital Implants; D019651:Plastic Surgery Procedures / Q000379:methods*; D019572:Retinal Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D012175:Retinoblastoma / Q000532:radiotherapy* / Q000601:surgery*; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000098:blood supply*; D016896:Treatment Outcome