Orbital outcomes after orbit-sparing surgery and free flap reconstruction.

OBJECTIVE

To identify functional outcome and orbital complication rate of the preserved orbit and to identify predictors of orbital impairment in periorbital free flap reconstruction.

MATERIALS AND

METHODS

A retrospective review was conducted on patients undergoing orbit-sparing surgery with periorbital free flap reconstruction at a tertiary institution from 2006 to 2017. Orbital complication rate and orbital functional outcomes were analyzed. A univariable and multivariable logistic regression analysis was used to assess predictors of functional outcome.

RESULTS

Forty-nine patients met inclusion criteria. Ninety-eight percent of patients maintained a functional eye post-operatively. Most periorbital free flaps, 37 (75.5%), were performed following oncologic resection. Overall orbital function was graded as functional without impairment in 29 (59.2%) patients, functional with impairment in 19 (38.8%) patients, and nonfunctional in 1 (2.0%) patient. Postoperative orbital sequelae occurred in 32 (65.3%) patients. Twenty-one (42.9%) patients underwent 35 revision operations for late orbital sequelae. Extent of resection (OR, 5.93; CI 95%, 1.05-33.4; p = 0.044) and adjuvant RT (OR, 4.69; CI 95% 1.18-18.6; p = 0.028) significantly correlated with impairment in a functional orbit on multivariable analysis.

CONCLUSION

Orbit-sparing surgery with periorbital free flap reconstruction carries a significant risk of a variety of orbital sequelae, most commonly ectropion, requiring surgical intervention. However, most patients maintain a functional eye. The need for delayed exenteration/enucleation is low and is primarily limited to cancer recurrence. Significant predictors of complications include extent of resection and adjuvant radiation therapy.