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Reconstruction After Orbital Exenteration

Reconstruction After Orbital Exenteration In a recent article describing a useful well-known technique for reconstruction after orbital exenteration, Uusitalo and coworkers1 described a patient who underwent orbital exenteration for primary rhabdomyosarcoma. We find this surprising because the Intergroup Rhabdomyosarcoma Study found a 10-year overall survival rate of 87% with use of chemotherapy with or without adjunctive radiation.2 Our service (Oculoplastic and Orbital Surgery, Massachusetts Eye and Ear Infirmary, Boston, Mass) refers biopsy-proved cases of orbital rhabdomyosarcoma to pediatric oncology, where the present protocol includes 1 year of intravenous vincristine sulfate and dactinomycin with or without radiation. It would be interesting to know what specific characteristics of this case indicated exenteration. As the authors point out, the rectus abdominis myocutaneous free flap is useful in orbital reconstruction primarily because it produces a maintenance-free socket and is therefore desirable in pediatric cases. We have used this technique since 1990 in adult patients, such as those with schizophrenia, who cannot readily maintain a granulating orbit. We now offer this form of reconstruction to any patient who is medically fit. The benefits, however, must be weighed against the additional morbidity of abdominal surgery, especially in the elderly, who typically are the largest population undergoing orbital exenteration. References 1. Uusitalo MIbarra MFulton L et al. Reconstruction with rectus abdominis myocutaneous free flap after orbital exenteration in children. Arch Ophthalmol. 2001;1191705- 1709PubMedGoogle ScholarCrossref 2. Oberlin ORey AAnderson J et al. Treatment of orbital rhabdomyosarcoma: survival and late effects of treatment—results of an international workshop. J Clin Oncol. 2001;19197- 204PubMedGoogle Scholar http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Ophthalmology American Medical Association

Reconstruction After Orbital Exenteration

Reconstruction After Orbital Exenteration

Abstract

In a recent article describing a useful well-known technique for reconstruction after orbital exenteration, Uusitalo and coworkers1 described a patient who underwent orbital exenteration for primary rhabdomyosarcoma. We find this surprising because the Intergroup Rhabdomyosarcoma Study found a 10-year overall survival rate of 87% with use of chemotherapy with or without adjunctive radiation.2 Our service (Oculoplastic and Orbital Surgery, Massachusetts Eye and Ear Infirmary, Boston, Mass)...
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Publisher
American Medical Association
Copyright
Copyright © 2003 American Medical Association. All Rights Reserved.
ISSN
0003-9950
eISSN
1538-3687
DOI
10.1001/archopht.121.11.1662-a
Publisher site
See Article on Publisher Site

Abstract

In a recent article describing a useful well-known technique for reconstruction after orbital exenteration, Uusitalo and coworkers1 described a patient who underwent orbital exenteration for primary rhabdomyosarcoma. We find this surprising because the Intergroup Rhabdomyosarcoma Study found a 10-year overall survival rate of 87% with use of chemotherapy with or without adjunctive radiation.2 Our service (Oculoplastic and Orbital Surgery, Massachusetts Eye and Ear Infirmary, Boston, Mass) refers biopsy-proved cases of orbital rhabdomyosarcoma to pediatric oncology, where the present protocol includes 1 year of intravenous vincristine sulfate and dactinomycin with or without radiation. It would be interesting to know what specific characteristics of this case indicated exenteration. As the authors point out, the rectus abdominis myocutaneous free flap is useful in orbital reconstruction primarily because it produces a maintenance-free socket and is therefore desirable in pediatric cases. We have used this technique since 1990 in adult patients, such as those with schizophrenia, who cannot readily maintain a granulating orbit. We now offer this form of reconstruction to any patient who is medically fit. The benefits, however, must be weighed against the additional morbidity of abdominal surgery, especially in the elderly, who typically are the largest population undergoing orbital exenteration. References 1. Uusitalo MIbarra MFulton L et al. Reconstruction with rectus abdominis myocutaneous free flap after orbital exenteration in children. Arch Ophthalmol. 2001;1191705- 1709PubMedGoogle ScholarCrossref 2. Oberlin ORey AAnderson J et al. Treatment of orbital rhabdomyosarcoma: survival and late effects of treatment—results of an international workshop. J Clin Oncol. 2001;19197- 204PubMedGoogle Scholar

Journal

Archives of OphthalmologyAmerican Medical Association

Published: Nov 1, 2003

Keywords: orbit evisceration,reconstructive surgical procedures

References