Purpose
Primary cutaneous squamous cell carcinoma (cSCC) and cutaneous basal cell carcinoma (cBCC) can invade into the orbit, necessitating exenteration. Local and free flaps are used for orbital reconstruction to reduce the risk of complications such as fistula formation. Local flaps provide low-volume closure of the defect, which may lead to increased rates of complications, but leaves a concave contour that can readily accept a prosthesis. Free flaps are bulkier with fewer complications but may hinder future rehabilitation. This audit aimed to determine the survival of patients following orbital exenteration for T3 and T4 primary cSCC and cBCC, to investigate the subsequent methods of reconstruction and their rates of complications and to gauge the impact of reconstruction on later orbital rehabilitation.
Method
Operating room data was searched to identify orbital exenterations at the Royal Brisbane and Women’s Hospital between 2009 and 2020. Medical records were examined and patients were included for final analysis if they had received exenteration for T3 or T4 primary cSCC and cBCC with subsequent reconstruction. Data were extracted for patient details, tumour characteristics, reconstruction method and complications and follow-up including survival and orbital rehabilitation.
Results
65 patients underwent orbital exenteration with reconstruction between 2009 and 2020. Survival did not differ between patient groups by tumour type or T stage. Two-thirds (66%) of reconstructions were performed with free flaps, with the most common being the anterolateral thigh free flap in 30 cases (46%). No difference was found in rates of complications or flap failure between those with free flaps and those with local flaps. Similarly, there was no difference in the rates of orbital prosthesis rehabilitation postoperatively between free flaps and local flaps.
Conclusion
All patients had comparable survival and reconstruction method did not appear to affect rates of complication or orbital rehabilitation at our centre.