Synchronous Reconstruction of the Exenterated Orbit with a Pericranial Flap, Skin Graft and Osseointegrated Implants

Abstract

Reconstruction of the exenterated orbit remains a surgical challenge. Here, the authors present a case in which orbital exenteration was performed for an extensive, infiltrating medial canthal basal cell carcinoma; the resulting defect was reconstructed with osseointegrated implants and a pericranial flap onto which a split thickness skin graft was placed. The second stage of the aesthetic rehabilitation of this patient (placement of the transcutaneous abutments) was completed under local anaesthetic 16 weeks later. Subsequently, the patient was fitted with an oculoplastic prosthesis four weeks later. The above technique accelerates the prosthetic rehabilitation of the patient by performing the primary reconstructive procedures simultaneously with the exenteration and by removing the need for secondary surgical procedures under general anaesthetics. The whole process from orbital exenteration to the fitting of an ocular prosthesis was completed in just five months.

KEYWORDS:

• Orbital exenteration
• pericranial flap
• osseointegrated implants
• split skin graft
• basal cell carcinoma
• orbital reconstruction
• orbital tumors