Eye socket reconstructions using free scapular flaps: Clinical experiences

It is difficult to create an effective ocular prosthesis for a severe eye socket injury if the patient has undergone postoperative radiotherapy for a retinoblastoma during infancy. However, due to recent advances made in microvascular surgery, free flap transplantations are being increasingly employed for eye socket reconstructions. In this study we report on our success in using scapular and parascapular flaps for the repair of eye socket deformities. Dorsalis pedis or forearm flaps that have been used for eye socket repairs can cause disfigurements and/or sensory disturbances, so to avoid both possibilities, we have tried using flaps that permit primary reefing from the scapular region where donor site wound scarring is fairly inconspicuous. Scapular and parascapular flaps have a thick dermis, so they are less easy to work with than, say, thin, flexible dorsalis pedis or forearm flaps. However, so long as remnants of the tipper and lower conjunctival fornices were available, we were able to use hinge-shaped flaps for linings and reconstructions of the upper and lower palpabrae. In this manner, free scapular flaps can be inserted into the eye socket as an ocular prosthesis without folding and since the dermis of this flap is thick, firm fixation to the upper and lower orbital rim can be achieved. We discuss the favorable results we have obtained by using scapular and parascapular flaps for eye socket repairs.