Annals of Case Reports (ISSN: 2574-7754)

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Reconstruction by ALT Composite Flap of the Orbit and Periorbita, Due To Tumor Enucleation "Case Report".

Daniel Pichardo Esquivel1, Jonathan Emmanuel Ponce Hernández2, Hector Adolfo Morales Yépez3, Eric Contreras Sibaja4, Luis Miguel Hernández García5, Paúl Robledo Madrid6, Rodrigo Banegas Ruiz7, Nadia Andrea Rodriguez García8, Miguel Ángel Canseco Fuentes8, Victoria E. Viurcos-Sanabria8, Erik A. Torre-Anaya9*

1Physician attached to the plastic surgery service of the Hospital Central Militar, Mexico

2Chief of the Academic Coordination Department of the Hospital Central Militar, Mexico

3Chief of the Plastic Surgery Service of the Hospital Central Militar, Mexico

4Chief of the Burn Unit of the Hospital Central Militar, Mexico

5Physician attached to the plastic surgery service of the Central Hospital, Mexico

6Fourth year plastic surgery resident at the Luis Guillermo Ibarra Ibarra National Rehabilitation Institute, Mexico

7Responsible researcher Physician attached to the traumatology service of the Luis Guillermo Ibarra Ibarra Ibarra National Institute of Rehabilitation, Mexico

8Member in training for plastic surgery, Mexico

9Master student at the Universidad Tecnológica de México, fellowship, Mexico

*Corresponding author: Erik A. Torre-Anaya, Universidad Tecnológica de México, Mexico City, Mexico

Received Date: 24 September 2022

Accepted Date: 27 September 2022

Published Date: 30 September 2022

Citation: Esquivel DP, Hernández JEP, Yépez HAM, Sibaja EC, García MH, et al. (2022) Reconstruction by ALT Composite Flap of the Orbit and Periorbita, Due To Tumor Enucleation "Case Report". Ann Case Report. 7: 969. DOI: https://doi.org/10.29011/2574-7754.100969

Abstract

Introduction: Presentation of a case of reconstruction of orbit and periorbita due to tumor enucleation with extension to the skin, using composite ALT flap, with the purpose of having a coverage of the lesion site, with adequate vascularity, decreasing the comorbidities of the donor site. This is a 74-year-old female patient with surgical wound after enucleation of squamous cell tumor with extension to the skin; referred for functional reconstruction by ALT composite myocutaneous flap. Result: adequate coverage and volume of the reconstructed area, favorable bed and vascularization of the flap, expected result from the first surgical act. Conclusion: the composite ALT flap has the advantage of giving adequate coverage and volume if it is removed with its muscular portion.

Keywords: ALT composite; Enucleation; Reconstruction.

Abbreviations: ALT: Anterolateral

Introduction

Presentation of a case of reconstruction of the orbit and periorbita by tumor enucleation with extension to the skin (Image 1). In oncologic reconstruction, the tumor lineage, the type of resection and the margins must be considered. In this way, a panorama of functional and cosmetic requirements is created, which will help us to select the technique with which to achieve the best result and improve the patient's quality of life [1]:

  1. Planning the reconstructive procedure in conjunction with the oncologic surgeon.
  2. Reconstruction with morpho-functional cosmetic units, especially in facial defects.
  3. Avoid using muscle when the defect is only cutaneous and volume is not desired.
  4. Choose tissue with similar characteristics to that of the defect site.
  5. Achieve the best result with a single procedure.

Figure 1: Post-enucleation lesion of the right orbit with extension to the skin.

The main objectives are to provide adequate coverage to deep tissues, especially bone, vascular and nervous structures that have been exposed, as well as to place healthy tissue with adequate vascularity to avoid injury by adjuvant treatment or the chronicity of the disease [2]; that is, we must ensure adequate skin coverage with defined vascular pattern, this in order to receive radiotherapy, chemotherapy and hormone therapy of the reconstruction area.

There are different types of flaps for reconstruction secondary to tumor resections. The choice of technique will depend on the type of lesion; extension and histology present [3]. The composite anterolateral flap (ALT) consists of including muscle, fascia or nerve [4]. This flap has the particularity and reliability of including intact the entire descending branch of the lateral femoral circumflex artery, and thus serve as a flow through flap, this has as indications and main utility, traumatic injuries of the extremities with vascular and cutaneous segmental loss; in chronic wounds where soft tissue coverage is required and there is a high degree of stenosis in the recipient vessel [5]. The anterolateral lateral flap (ALT) is obtained from the descending branch of the lateral femoral circumflex artery, which runs between the vastus lateralis and rectus femoris muscles. The venous drainage of the ALT flap depends on 2 veins that accompany the descending artery of the lateral femoral circumflex artery [6]. According to [7] the advantages and versatility are: the inclusion of different types of tissue in different combinations, reliable vascular anatomy, large extension cutaneous island, long vascular pedicle with adequate caliber, minimal morbidity at the donor site, and the possibility of implementing two surgical teams operating simultaneously.

Case Report

74-year-old female patient with a history of systemic arterial hypertension and surgical wound following enucleation of squamous cell tumor with extension to the skin; referred by the oncology service for functional reconstruction using ALT myocutaneous flap composed with vastus lateralis muscle (Figure 2).