Restoration of the Orbital Aesthetic Subunit with the Thoracodorsal Artery System of Flaps in Patients Undergoing Radiation Therapy

Abstract

Objectives To demonstrate the advantages of the thoracodorsal artery scapular tip autogenous transplant (Tdast) for patients requiring restoration of the orbital aesthetic subunit.

Design Prospective case series.

Setting Tertiary center.

Participants Ten patients (M:F,6:4) with a mean age of 56 years (range, 21 to 78 years) underwent restoration of the orbital aesthetic subunit and radiation therapy between 2001 and 2008.

Main Outcome Measures The two reconstructive advantages of the thoracodorsal artery system of flaps for orbital reconstruction are a long pedicle and the suitability of the scapula tip to meet the three-dimensional requirements of the orbit. Patients were assessed 1 year or more after treatment for cosmetic outcome, work status, and socialization.

Results Eight of 10 patients benefited from the three-dimensional nature of the scapula tip bone and 7 of 10 avoided vein grafting. Four of five evaluable patients reported “frequently” socializing outside their home. Four of five evaluable patients working before undergoing their treatment were able to return to work posttreatment. Seven of nine patients with postoperative photographs had minimal or no facial contour deformity.

Conclusions The Tdast can restore orbital contour without osteotomy, and the thoracodorsal artery system of flaps has a long vascular pedicle that reduces vein grafting. Patients have an acceptable cosmetic result and return to preoperative work status and socialization.

Keywords

thoracodorsal artery scapular tip autogenous transplant - Tdast - scapula - orbit - orbital evisceration

• References

• 1 Moyer JS, Chepeha DB, Prince ME, Teknos TN. Microvascular reconstruction of the orbital complex. Facial Plast Surg Clin North Am 2009; 17 (2) 225-237
• 2 Hanasono MM, Lee JC, Yang JS, Skoracki RJ, Reece GP, Esmaeli B. An algorithmic approach to reconstructive surgery and prosthetic rehabilitation after orbital exenteration. Plast Reconstr Surg 2009; 123 (1) 98-105
• 3 Kim JY, Buck II DW, Johnson SA, Butler CE. The temporoparietal fascial flap is an alternative to free flaps for orbitomaxillary reconstruction. Plast Reconstr Surg 2010; 126 (3) 880-888
• 4 Chepeha DB, Wang SJ, Marentette LJ , et al. Restoration of the orbital aesthetic subunit in complex midface defects. Laryngoscope 2004; 114 (10) 1706-1713
• 5 Uglesić V, Virag M, Varga S, Knezević P, Milenović A. Reconstruction following radical maxillectomy with flaps supplied by the subscapular artery. J Craniomaxillofac Surg 2000; 28 (3) 153-160
• 6 Chepeha DB, Khariwala SS, Chanowski EJ , et al. Thoracodorsal artery scapular tip autogenous transplant: vascularized bone with a long pedicle and flexible soft tissue. Arch Otolaryngol Head Neck Surg 2010; 136 (10) 958-964
• 7 Funk GF, Laurenzo JF, Valentino J, McCulloch TM, Frodel JL, Hoffman HT. Free-tissue transfer reconstruction of midfacial and cranio-orbito-facial defects. Arch Otolaryngol Head Neck Surg 1995; 121 (3) 293-303
• 8 Chepeha DB, Teknos TN, Shargorodsky J , et al. Rectangle tongue template for reconstruction of the hemiglossectomy defect. Arch Otolaryngol Head Neck Surg 2008; 134 (9) 993-998
• 9 Kosutic D, Uglesic V, Knezevic P, Milenovic A, Virag M. Latissimus dorsi-scapula free flap for reconstruction of defects following radical maxillectomy with orbital exenteration. J Plast Reconstr Aesthet Surg 2008; 61 (6) 620-627
• 10 Clark JR, Vesely M, Gilbert R. Scapular angle osteomyogenous flap in postmaxillectomy reconstruction: defect, reconstruction, shoulder function, and harvest technique. Head Neck 2008; 30 (1) 10-20
• 11 Kim SS, Kawamoto HK, Kohan E, Bradley JP. Reconstruction of the irradiated orbit with autogenous fat grafting for improved ocular implant. Plast Reconstr Surg 2010; 126 (1) 213-220