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Marita Uusitalo, MD, PhD; Michael Ibarra, MD; Lilia Fulton, BA; Michael Kaplan, MD; William Hoffman, MD; Chen Lee, MD; Susan Carter, MD; Joan O'Brien, MD

Arch Ophthalmol. 2001;119:1705-1709.

Objective  To present a 1-stage technique for orbital reconstruction after exenteration with the use of myocutaneous rectus abdominis free flap in children.

Surgical Technique  After orbital exenteration, a myocutaneous rectus abdominis free flap with long vascular pedicle is harvested from the abdomen. The flap is transferred to the orbit and the vascular pedicle is passed through an opening made in the lateral orbital wall, where it is anastomosed to superficial temporal vessels. The skin of the flap is trimmed to correspond to the eyelid defect and the incisions are closed.

Methods  After informed consent was obtained, 2 children, 3 and 8 years old, underwent orbital reconstruction with a rectus abdominis free flap after exenteration for orbital rhabdomyosarcoma and orbital osteosarcoma in the setting of retinoblastoma.

Results  This technique allowed easy postoperative wound care. Viability of the flap was excellent. The technique provided sufficient volume to fill the orbit, with improved aesthetic results and minimal donor site deformity.

Conclusions  The postoperative care and aesthetic outcome in patients with rectus abdominis free flap after exenteration are much improved over those provided with traditional surgical techniques. This primary reconstruction is recommended for any patient requiring orbital exenteration, but particularly for pediatric patients who tolerate debridement of traditional exenteration sites poorly.

From the Departments of Ophthalmology (Drs Uusitalo, Ibarra, Carter, and O'Brien and Ms Fulton), Otolaryngology (Dr Kaplan), and Surgery (Drs Hoffman and Lee), University of California, San Francisco; and Department of Ophthalmology, Helsinki University Central Hospital, Helsinki, Finland (Dr Uusitalo).

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