Reconstruction of the exenterated orbit with an island pericranial flap – a new surgical approach

Background Reconstruction of the bony socket after orbital exenteration is a matter of much debate. Prompt defect closure with a vascularized graft is desirable, but involves a major surgical procedure and hence places considerable burden on the patient. The new surgical technique presented here permits technically simpler wound closure with fewer complications after classic orbital exenteration.

Methodology/Principle Between May 2014 and February 2019 in the ENT Department of Regensburg University, 8 patients underwent exenteration and reconstruction with a periosteal (pericranial) flap. The graft was raised via a broken line incision in the forehead or endoscopically, incised, then introduced into the orbit through a tunnel in the eyebrow. A retrospective analysis of the patients and theoretical considerations about determining the size, shape and vascular supply of the flap graft are presented.

Results Flap healing was uncomplicated in all cases. Only 6 weeks after surgery, the flap was stable, making it possible to start adjuvant therapy and prosthetic rehabilitation swiftly. The mean (± standard deviation) surface area of the measured orbits is 39.58 ± 3.32cm². The territory of the angular artery provides the periosteal flap arterial blood supply. Venous drainage is probably via fine venous networks surrounding the artery.

Conclusions Use of the pericranial flap makes it possible to close the orbital cavity promptly with minimal donor site defect and a short operating time, thereby minimizing the surgical risk and speeding up physical and psychological recovery.

Poster-PDF A-1309.PDF

Publication History

Article published online:
10 June 2020