Aesthetic microvascular periorbital subunit reconstruction:  beyond primary repair.
BACKGROUND
Reconstructing periorbital defects is challenging because of the simultaneous need for ocular support, corneal protection, and restoration of aesthetic subtleties. In patients with extensive periorbital tissue loss, microvascular free tissue transfer is a reliable reconstructive option for composite defects.


METHODS
The authors conducted a retrospective review of patients with periorbital craniofacial defects and identified those treated with microvascular reconstruction at the R Adams Cowley Shock Trauma Center and The Johns Hopkins Hospital from 2001 to 2010.


RESULTS
Twenty-four patients underwent free flap reconstruction for periorbital defects secondary to trauma (n = 12), oncologic resection (n = 11), and congenital deformity (n = 1). The majority were men (n = 13), and the average age of the patients was 47 years (range, 19 to 80 years). Microvascular reconstructions included fibula (n = 9), anterolateral thigh (n = 6), ulnar forearm (n = 7), and groin flaps (n = 2). Flap survival rate was 100 percent, with an average follow-up of 26.5 months.


CONCLUSIONS
Microvascular reconstruction of the periorbit can be accomplished successfully through careful analysis of tissue loss, eye or ocular prosthetic support, donor-site morbidity, and patient preference. Despite the multiple flap options that fulfill periorbital reconstructive needs, the authors find that the fibula, anterolateral thigh, ulnar forearm, and groin flaps can be used reliably to successfully reconstruct these defects.


METHODS
Therapeutic, IV.
Baltimore, Md. From the Division of Plastic, Reconstructive, and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, and the Center for Prosthetic Restoration.
Daniel E
DE
Borsuk
Joani
J
Christensen
Amir H
AH
Dorafshar
Branko
B
Bojovic
Paula J
PJ
Sauerborn
Michael R
MR
Christy
Eduardo D
ED
Rodriguez
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D004954:Esthetics; D005145:Face / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D055806:Microvessels / Q000601:surgery; D008875:Middle Aged; D009915:Orbit / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013524:Surgical Flaps; D055815:Young Adult