Reconstruction with rectus abdominis myocutaneous free flap after orbital exenteration in children

Objective: To present a 1-stage technique for orbital reconstruction after exenteration with the use of myocutaneous rectus abdominis free flap in chi ldren. Surgical Technique: After orbital exenteration, a myocutaneous rectus abdom inis free flap with long vascular pedicle is harvested from the abdomen. Th e flap is transferred to the orbit and the vascular pedicle is passed throu gh 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 s etting of retinoblastoma. Results: This technique allowed easy, postoperative wound care. Viability o f the nap was excellent. The technique provided sufficient volume to fill t he 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 particu larly for pediatric patients who tolerate debridement of traditional exente ration sites poorly.