Objective. To detail the clinical outcomes of a series of patients having undergone free flap reconstruction of the orbit and periorbita\r\nand highlight the anterolateral thigh (ALT) as a workhorse for addressing defects in this region. Methods. A review of 47 patients\r\nwho underwent free flap reconstruction for orbital or periorbital defects between September 2006 and May 2011 was performed.\r\nData reviewed included demographics, defect characteristics, free flap used, additional reconstructive techniques employed, length\r\nof stay, complications, and follow-up. The ALT subset of the case series was the focus of the data reviewed for this paper. Selected\r\ncases were described to highlight some of the advantages of employing the ALT for cranio-orbitofacial reconstruction. Results. 51\r\nfree flaps in 47 patients were reviewed. 38 cases required orbital exenteration. The ALT was used in 33 patients. Complications\r\nincluded 1 hematoma, 2 wound infections, 3 CSF leaks, and 3 flap failures. Conclusions. Free tissue transfer allows for the safe and\r\neffective reconstruction of complex defects of the orbit and periorbital structures. Reconstructive choice is dependent upon the\r\nextent of soft tissue loss, midfacial bone loss, and skullbase involvement. The ALT provides a versatile option to reconstruct the\r\nmany cranio-orbitofacial defects encountered.
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