Reconstruction of the eyelids and nose after a burn injury using a radial forearm flap

Aesthetic and Functional Reconstruction of Periorbital Region Using Radial Forearm Free Flap

Background

This study describes the utilization of the radial forearm free flap (RFFF) for the restoration of severe soft tissue deficiency involving the upper and lower eyelids in three patients.

Methods

This study is a retrospective review of the senior authors' clinical records for patients who presented with periorbital defect and underwent reconstruction with RFFF between 2018 and 2022.

Results

As a part of a comprehensive reconstructive surgery, we used the RFFF to deliver an ample amount of well-vascularized soft tissue. The flap's vessels were anastomosed to the ipsilateral facial vessels in all cases. Patients showed significant functional improvement, with complete eyelid closure achieved. No immediate postoperative complications were noted.

Conclusions

RFFF demonstrated optimal outcomes in upper eyelid reconstruction.

Orbital floor reconstruction via autologous radial forearm free flap with palmaris longus tendon

We describe reconstruction of the orbital floor following suprastructure maxillectomy for resection of maxillary squamous cell carcinoma utilizing an osteocutaneous radial forearm free flap and palmaris longus tendon.

Dynamic Upper Eyelid Reconstruction for Total Periorbital Soft Tissue Loss

Total eyelid defect comprises full-thickness loss of both upper and lower eyelids in a patient. It is a rare and devastating condition with serious implications related to vision, which mandates early and functional reconstruction when associated with intact globe. The primary goal is to give a stable coverage for orbital protection but at the same time provide a functional reconstruction of the defect, to allow for adequate mobility of the eyelids so that the patient's vision is restored to normal with minimal disability. When the defect is massive, and in the absence of loco-regional flaps, microvascular tissue transfer is needed. In this report we describe a radial-artery-based microvascular tissue transfer with a unique innovation utilizing the contralateral frontalis muscle to reconstruct a case of unilateral total upper and lower eyelid loss.

Burns: treatment and outcomes

Burns can cause extensive and devastating injuries of the head and neck. Prevention of the initial injury must always be a priority, but once an injury has occurred, then prevention of progression of the damage together with survival of the patient must be the immediate goals. The acute care will have a major influence on the subsequent scarring, reconstructive need, and long-term outcome. In the majority of cases, the reconstruction will involve restoration of form and function to the soft tissues, and the methods used will depend very much on the extent of scarring locally and elsewhere in the body. In nearly all cases, a significant improvement in functional and aesthetic outcomes can be achieved, which, in conjunction with intensive psychosocial rehabilitation, can lead to high-quality patient outcomes. With the prospect of facial transplantation being a clinical reality, the reconstructive spectrum has opened up even further, and, with appropriate reconstruction and support, no patient should be left economically deprived or socially isolated after a burn injury.

Simultaneous upper and lower eyelid reconstruction using a first web space free flap

The authors present a case of near-total upper and lower eyelid defects treated with a first web space free flap after a chemical burn injury. A first web space free flap was raised from the ipsilateral foot and transferred to the defect with its base turned toward the medial canthal area. The first dorsal metatarsal artery and veins were anastomosed to the superficial temporal artery and veins, respectively. The inner layer of the flap was sutured to the advanced upper and lower palpebral conjunctival flap from conjunctival cul-de-sacs, and the outer layer of the flap was sutured to the defected skin. Flap-debulking procedures were carried out 3 times after the microsurgical procedure. Postoperative aesthetic results were good, except for minor problems that included focal symblepharon and sebum formation. The described method could be used as an alternative for total eyelid reconstruction, especially in patients without available local facial tissue because of burns or trauma.

Eyelid reconstruction with a composite radial forearm palmaris longus tendon flap

We performed reconstruction with a composite radial forearm palmaris longus tendon flap in patients with wide defects of upper or lower eyelids. In one upper eyelid reconstruction, a palmaris longus tendon was fixed to the frontal muscle to make it possible to open the eye. In the lower eyelid reconstruction, the tendon was fixed to both the medial palpebral ligament and the lateral orbital rim to support the flap. In wide upper and lower eyelid reconstruction with a forearm flap, it is convenient to utilise the palmaris longus tendon to support the flap.