Synergistic 3D Approach with Plastic Surgery and Anaplastology to Achieve Optimal Facial Restoration after Oncologic Orbital Exenteration

While the primary goal of reconstruction following orbital exenteration is lining or filling of the defect to protect the cranial contents, orbital exenteration without full rehabilitative efforts is debilitating to patients due to the resulting psychosocial disability [4,5]. Therefore, many patients strongly desire to obtain a prosthetic [2,3]. Typically, open cavity reconstruction of the orbital socket is the preferred method when postoperative use of an orbital prosthesis is planned [8]. However, in this case, closed cavity reconstruction was chosen over open cavity reconstruction to optimize flap viability and protect the cranial contents due to planned future radiation treatments. Due to the bulky nature of closed cavity reconstruction, unique challenges were encountered and more extensive reconstructive surgery was required to ensure a secure fit of an orbital prosthesis. The initially bulky VRAM flap limited the ability to place an orbital prosthesis, thus hindering anaplastologist prosthetic rehabilitative efforts. However, there was concern that overly aggressive debulking would potentially compromise flap perfusion in the setting of previous radiation. Furthermore, irradiated sites have been shown to be at greater risk for tissue necrosis when subjected to prosthetics and implant surgery [10].