Anatomic study and preliminary clinical application of the laterally based pericranial flap to treat traumatic enophthalmos

Objective:To assess the vascularization of the laterally based pericranial flap and the feasibility of bony channel on the orbital lateral wall for transplantation of the flap,and apply this flap to treat traumatic enophthalmos.Methods: Two formalin preserved cadaver specimens were anatomized to observe the feasibility of pericranial flap transplantation through the bony channels on lateral orbital walls.Two fresh cadaver specimens were perfused with latex and ink respectively to observe the possible blood supply to laterally based pericranial flaps.Two patients with unilateral old orbital fracture were treated using this flap.The enophthalmos degrees were measured before and after operation to evaluate the effect of this therapy.Results: It was feasible to transplant the pericranial flap into orbit through the bony channel on lateral orbital wall,reaching the medial wall and orbital floor.Vascular perfusion did not reveal that the laterally based pericranial flap over the supra temporal line was vascularized by any axial vessel.The ink perfusion of one side showed that the middle temporal artery extended deeply under the deep temporal fascia,but didn't cross the supra temporal line.The subgaleal vascular plexus was observed obviously in the superficial layer of pericranial flap.The enophthalmos degrees of the two patients were respectively 5.35 mm and 6.86 mm prior to operation.They both showed desirable outcomes postoperation( 2 mm).Conclusion: It is feasible to transfer the laterally based pericranial flap into orbit through the lateral orbital wall channel.The laterally based pericranial flap is possibly vascularized by the subgaleal vascular plexus.The primary treatment of traumatic enophthalmos using the laterally based pericranial flap is satisfactory.