The Free Serratus-Rib Flap for Orbital Floor Reconstruction after Oncologic Resection

Introduction: Maxillary cancer is relatively rare but devastating for those affected with the disease. For patients who require suprastructural or total maxillectomy for oncologic resection, the resection of the orbital floor can be challenging to reconstruct. The serratus-rib flap is a well-known and useful method of head and neck reconstruction, albeit infrequently used. However, the serratus-rib flap has not previously been described for reconstruction of the orbital floor and has the potential to provide excellent globe support after orbital floor resection in patients after undergoing maxillectomy. Methods: We retrospectively reviewed all patients who had undergone orbital floor reconstruction using the serratus-rib osteomyofascial free flap by the senior author throughout their career. Surgical technique, postoperative course, complications, and additional required procedures were evaluated. Results: Six patients were found to have undergone the serratus-rib osteomyofascial free flap for orbital floor reconstruction. Average follow-up was 26.7 months from initial surgery. Fifty percent of patients had later minor revision surgery such as fat grafting or scar revision. No patients had any significant complications, and all patients were noted to have good ocular function without diplopia postoperatively. Conclusion: The serratus-rib osteomyofascial free flap is an efficacious method for reconstruction of the orbital floor after oncologic resection. Surgeons should consider this flap when performing orbital floor reconstruction, particularly when dead space also needs to be filled with the use of a free flap.