Imai Yoshie, Kadota Hideki, Kogo Ryunosuke
Department of Plastic and Reconstructive Surgery, Kyushu University Hospital.
Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
J Craniofac Surg. 2024 Aug 26. doi: 10.1097/SCS.0000000000010571.
Orbital reconstruction after total maxillectomy is essential to maintain ocular function and facial contour. Free flap transfer with simultaneous orbital bone reconstruction is a straightforward approach; however, it is challenging in medically unstable patients with multimorbidity. The authors developed an easily harvested temporoparietal fascial flap combined with vascularized outer table calvarial bone and entire temporalis muscle. The authors applied this technique in an 81-year-old patient with multiple comorbidities who required orbital floor reconstruction following total maxillectomy. Intraoperative indocyanine green fluorescence imaging confirmed excellent perfusion of the temporoparietal fascia, entire temporalis muscle, and calvarial bone. Although the patient developed postoperative local wound infection, the vascularized bone graft resisted infection and preserved the orbital structure without bone exposure. Our technique is minimally invasive and results in a well-vascularized flap for orbital reconstruction after total maxillectomy involving the orbital bone, and particularly beneficial in patients with multimorbidity or at high risk of local infection.
全上颌骨切除术后的眼眶重建对于维持眼功能和面部轮廓至关重要。游离皮瓣移植同时进行眼眶骨重建是一种直接的方法；然而，对于患有多种疾病且病情不稳定的患者来说具有挑战性。作者研发了一种易于切取的颞顶筋膜瓣，其结合了带血管的颅骨外板和完整的颞肌。作者将该技术应用于一名81岁患有多种合并症的患者，该患者在全上颌骨切除术后需要进行眶底重建。术中吲哚菁绿荧光成像证实颞顶筋膜、完整的颞肌和颅骨的灌注良好。尽管患者术后出现局部伤口感染，但带血管的骨移植抵抗了感染，保留了眼眶结构且无骨质暴露。我们的技术微创，可为累及眼眶骨的全上颌骨切除术后眼眶重建提供血运良好的皮瓣，尤其对患有多种疾病或局部感染高危患者有益。
