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Surgery: Current Research | ISSN: 2161-1076 | Volume 8
August 31-September 01, 2018 | Toronto, Canada
Plastic & Cosmetic Surgery
International Conference on
Dermatopathology & Skin Care
International Conference & Expo on
&
Reconstruction of a periorbital defect with radial forearm free flap following necrotising fasciitis
Laura Bamford
York Teaching Hospital, UK
Introduction:
A 43-year-old male presented with a 2-day history of increased pain and swelling around his right periorbital
region following a small abrasion to his eyebrow. On presentation, necrotizing fasciitis was clinically diagnosed. Two-stage
debridement involved the extensive sacrifice of extensive soft tissues including orbicularis oculi and levator muscles and
eyelids, the globe was spared.
Reconstruction:
The reconstructive challenge included separate coverage of the eyelid and minimizing bulk to the surrounding
periorbital region. This case was jointly managed with the Oculoplastic Surgeons. Previously documented reconstruction with
myofascial free flaps has led to unwieldy flaps with aesthetically poor results. To maximize the aesthetic result skin grafts from
the upper arm were grafted to the eyelids and were then completely covered with a 10x7cm soft tissue radial forearm free flap
(RFFF) utilizing cephalic venous drainage. This was anastomosed to the facial vessels. Secondary surgery was performed 8
weeks later involving division of the flap, uncovering the skin graft and debulking to provide contour.
Conclusion:
In this unusual case, composite reconstructive approaches were combined to overcome a unique challenge.
This is the first described case of using RFFF for reconstruction of the periorbital region following such extensive tissue loss,
whilst maintaining the function of the eye following necrotizing fasciitis. The RFFF provided excellent short and long-term
reconstruction. It protected the eyelid skin grafts and matched the facial contours well. Division of the flap following the
establishment of the collateral blood supply was straightforward and well tolerated. We would recommend its consideration
for facial defect consideration once the acute infection is cleared.
Biography
I graduated from the University of Leeds, UK, with BChD in Dental Surgery. I am currently enjoying my second year as a Senior House Officer (or Core Trainee 2) in
the Oral and Maxillofacial Surgery unit at York Teaching Hospital NHS FT. I am deputy editor of the Patient Safety Matters Staff Bulletin for the hospital. Prior to this
I worked briefly as a Work Psychologist as I hold both a BSc and MSc in Psychology. It is my intention to compete a third SHO year before returning to university
to study medicine, to embark on a career as a Maxillofacial surgeon.
Laura.Bamford@york.nhs.ukLaura Bamford, Surgery Curr Res 2018, Volume 8
DOI: 10.4172/2161-1076-C4-044