Efficacy of Surgical Reconstruction With Rectus Abdominis Flap Following en Bloc Resection of the Orbital Contents for Malignant Lacrimal Gland Cancer: A Case Series

In cases of lacrimal gland carcinoma requiring surgical excision of the orbital contents, skull base, and surrounding bones, definitive blockage of the cranial cavity and reconstruction of the anterior skull base with irradiation-acceptable tissue (for possible subsequent radiotherapy) is necessary. However, considerations for quality of life, including cosmetic aspects, such as artificial eye placement and contour morphology, make reconstruction challenging. In three cases of advanced lacrimal gland carcinoma, we performed a reconstruction surgery following an en bloc resection of the orbital contents and lateral orbital bones. A rectus abdominis flap was used, considering both function and morphology. This flap, characterized by reliable anatomical structure and good blood flow, adequately filled the three-dimensional dead space. In our case, the flap fully survived, and no complications such as cerebrospinal fluid leakage or meningitis were observed. Six months after surgery, the flap volume was 31.7-73.3% of its initial size. Considering potential flap shrinkage in the future, it was deemed beneficial to use a slightly excessive volume.