Restoration of the Orbital Aesthetic Subunit with the Thoracodorsal Artery System of Flaps in Patients Undergoing Radiation Therapy

• Published in: Journal of neurological surgery. Part B, Skull base Vol. 74; no. 5; pp. 279 - 285
• Main Authors: Chanowski, Eric J.P., Casper, Keith A., Eisbruch, Avraham, Heth, Jason A., Marentette, Lawrence J., Prince, Mark E., Moyer, Jeffrey S., Chepeha, Douglas B.
• Format: Journal Article
• Language: English
• Published: Stuttgart · New York Georg Thieme Verlag KG 01-10-2013
• Subjects: Original Article; orbital evisceration; orbit; thoracodorsal artery scapular tip autogenous transplant; Tdast; scapula
• ISSN: 2193-6331; 2193-634X
• DOI: 10.1055/s-0033-1347366

Abstract
Objectives
 To demonstrate the advantages of the thoracodorsal artery scapular tip autogenous transplant (Tdast) for patients requiring restoration of the orbital aesthetic subunit.
Design
 Prospective case series.
Setting
 Tertiary center.
Participants
 Ten patients (M:F,6:4) with a mean age of 56 years (range, 21 to 78 years) underwent restoration of the orbital aesthetic subunit and radiation therapy between 2001 and 2008.
Main Outcome Measures
 The two reconstructive advantages of the thoracodorsal artery system of flaps for orbital reconstruction are a long pedicle and the suitability of the scapula tip to meet the three-dimensional requirements of the orbit. Patients were assessed 1 year or more after treatment for cosmetic outcome, work status, and socialization.
Results
 Eight of 10 patients benefited from the three-dimensional nature of the scapula tip bone and 7 of 10 avoided vein grafting. Four of five evaluable patients reported “frequently” socializing outside their home. Four of five evaluable patients working before undergoing their treatment were able to return to work posttreatment. Seven of nine patients with postoperative photographs had minimal or no facial contour deformity.
Conclusions
 The Tdast can restore orbital contour without osteotomy, and the thoracodorsal artery system of flaps has a long vascular pedicle that reduces vein grafting. Patients have an acceptable cosmetic result and return to preoperative work status and socialization.