Introduction: Orbital reconstructions are challenging surgical procedures that are usually multi-staged. Therefore, they require patients’ patience in order to maintain mental and physical balance. We present a novel modification of the Anterolateral Thigh (ALT) flap-based orbital reconstruction with simultaneous implant placement for conjunctival sac reconstruction.
Materials and Methods: A 41-year-old patient, with a secondary defect to an injury with technical oil under high pressure, was admitted to the Plastic Surgery Department of the Specialist Medical Center. St. John Paul the II in Polanica Zdrój. The patient suffered from a total absence of orbital soft tissues and numerous scars after previous unsuccessful reconstructions with local flaps. The patient underwent simultaneous reconstruction of the soft tissues of the orbit, eyelids, and conjunctival sac based on a prefabricated ALT flap. The flap was covered with a full-thickness skin graft (FTSG) from the retroauricular area. The conjunctival sac was created by an acrylic conformer implant wrapped with a split-thickness skin graft (STSG) from the thigh. In the final stage, the eyelids were reconstructed using a simple local plasty technique.
Results: No postoperative complications were observed. At present, the patient is delighted with the functional and aesthetic results of the reconstruction.
Conclusion: Our case report proves that simultaneous reconstruction of the soft tissues of the orbit, conjunctival sac, and eyelids is a manageable technic that can significantly improve the quality of life of patients after exenteration. More procedures need to be performed to refine the method and create a standardized algorithm.