Combination of Mustardè cheek advancement flap and paramedian forehead flap as a reconstructive option in orbital exenteration

Abstract

Purpose: To describe a combinatory technique made of Mustardè cheek advancement flap and paramedian forehead flap as a reconstructive option after orbital exenteration. Methods: We retrospectively reviewed all patients who underwent orbital exenteration and subsequent reconstruction with this technique at our Head and Neck Department, Divisions of Ophthalmology and Otolaryngology, at San Raffaele Hospital, Milan, Italy. Results: Three patients were treated with the aforementioned technique, following orbital exenteration due to malignancies. All of them were affected by recurrent diseases arising from the ocular components or periorbital structures: one basal cell carcinoma and two squamous cell carcinomas. Excellent result was achieved considering skin texture and colour match, aesthetic results and intra and post-operative complications (only minor, surgically controlled haemorrhage and minimal dehiscence subsequent to defective healing occurred). Conclusion: The proposed technique can be considered by the head and neck reconstructive surgeon as a good option in extended orbital exenteration.

Combination of Mustardé cheek advancement flap and paramedian forehead flap as a functional and aesthetic alternative

“…This approach varies according to tumor size, depth, and location. It allows the microscopic examination of the entire surgical margins during surgery so that the extent of excision can be defined precisely [ 8 ]. In our case, we used a 10 mm strip margin with a double scalpel blade to ensure the quality of the biopsy sample and, subsequently, the oncological results.…”

“…The second flap was a cheek rotational (Mustardé) flap designed in the 1960s. Some studies [ 8 , 10 ] mentioned that the combination of both flaps has a significant benefit in closing large defects in terms of mobility of mid and lateral cheek due to the unique features of the skin, excellent color and texture match, wide-based pedicle flap with appropriate vascularity and good aesthetic outcome. A large study of 116 patients demonstrated a low rate of recurrence of BCC in those cases where flaps and grafts were used in the surgical reconstruction with pre-established margins by the conventional method [ 11 ].…”

Head and neck pedicled flap autonomization using a new high‐resolution indocyanine green fluorescence video‐angiography device

“…Head and neck tumors often need a reconstructive phase with pedicled or free flaps after the ablative surgery 1–6 . Some pedicled flaps, such as the supraclavicular flap or the paramedian forehead flap (PFF), may require a second‐stage pedicle division and inset after the initial harvesting, a procedure consisting of pedicle division generally performed at least 3 weeks after the former one to let flap inosculation occur 7 …”

“…Head and neck tumors often need a reconstructive phase with pedicled or free flaps after the ablative surgery. [1][2][3][4][5][6] Some pedicled flaps, such as the supraclavicular flap or the paramedian forehead flap (PFF), may require a second-stage pedicle division and inset after the initial harvesting, a procedure consisting of pedicle division generally performed at least 3 weeks after the former one to let flap inosculation occur. 7 Several techniques are commonly used for perfusion assessment of the flaps, including simple visual observation, Doppler ultrasound, tissue oximetry, and indocyanine green (ICG) fluorescence video-angiography.…”

Benefits of Combined Surgical Techniques in Otoplasty

“…4 Many surgeons try to create their own standard method using the method they find safe or a combination of various methods. 6 - 11 The first reported surgical approach was by Dieffenbach in 1845. 12 The aim of the surgery is to create a natural antihelix and conchal cartilage and to correct the concomastoid angle.…”