Multidisciplinary orbital reconstructive surgery

The operation was performed on a 31-year-old female patient with neurofibromatosis. Due to the disease, the patient had been operated on several times in her childhood. In recent years, she was under the care of the Neurosurgical Outpatient Clinic of SPSK No. 4 in Lublin.

- Normally, during medical procedures performed in the Clinical Department of Neurosurgery and Pediatric Neurosurgery , it is not necessary to perform skin pl ication at the same time, i.e. a transplant from another part of the patient ' s body. In this particular case, the tumor grew from the orbit and spread into the facial skin and subcutaneous tissue , deforming the face. Due to the size of the tumor, the operation involved removing about 30 percent of the patient 's face. Removal of the tumor without simultaneous reconstruction of such a large defect would have been impossible. Therefore, in this case we planned to perform a multidisciplinary operation, during which laryngologists, anesthesiologists and plastic surgeons, in addition to neuro surgeons, would be present in the operating room ," explains neurosurgeon from the Clinical Department of Neurosurgery and Pediatric Neurosurgery at SPSK No. 4 Rafal Kruk.

Interdisciplinary team

The operation on the 31-year-old patient was a multidisciplinary operation involving a large team of specialists in various medical fields. Anesthesiologist lek. Ewa Gajewska supervised the proper course of anesthesia while maintaining normal vital signs and the safe awakening of the patient at the end of the procedure. Neurosurgeon lek. Rafal Kruk and otolaryngologist Dr. Adam Klos, M.D., removed part of the tumor including orbital evisceration and removal of adjacent structures. The doctors then prepared the patient for the implantation of the skin flap, which was the task of specialists in plastic surgery and microsurgery - Professor Kamil Torres, MD, Vice-Rector for Education and Didactics at the Medical University of Lublin, and Sergey Antonov, MD, PhD.

- This was the first operation of this type at SPSK No. 4 in Lublin in which we participated. Patients who are waiting for this type of surgery are in a kind of niche. There are very few centers for plastic, reconstructive and microsurgery in Poland . The closest specialized unit in this direction is in Warsaw. Reconstructive procedures require a highly qualified team with excellent spatial imagination and skills. Meanwhile, in every large center there are surgeries to remove a tumor or a fragment of the body, which, in addition to the medical effect , not infrequently produce a cosmetic effect that is difficult for patients to accept and hinders function . Having the defect reconstructed at the same time in one operation makes it easier for patients to accept themselves after surgery . But that's not all - in some cases the reconstruction restores the patient's function. We recently performed surgery on a patient with a ruptured Achilles tendon. The resulting defect of about 10 by 12 centimeters made the woman unable to move. Thanks to my team ' s relocation of the flaps to activate the limb, the patient can walk again," explains Prof. Kamil Torres, MD.

In the Clinical Department of Otolaryngology at the SPSK No. 4 in Lublin, reconstructive procedures using microsplit flaps have been performed for years. They mainly concern structures in the head and neck, but the department's specialists also participate in reconstructive surgeries for patients from the departments of orthopedics, neurosurgery and general surgery.

- In a 31-year-old patient, it was necessary to remove the tumor with a margin of healthy tissue . During this type of surgery, it is not possible to replenish the resulting defect with tissues from the surrounding area. In such situations, reconstructive surgery is very useful. This is when the defect is supplemented with a free tissue flap taken from another part of the body and the vessels of the two fragments are anastomosed ," explains Adam Klos, MD, from the Clinical Department of Otolaryngology at SPSK No. 4 in Lublin.

- After the 31-year-old patient 's surgery, we performed more procedures. We plan to expand the scope of surgery to include high-precision surgery, called microsurgery. These types of procedures are performed under a microscope on very small structures. They require special equipment, including microsurgical instruments, and a team of specialists trained in this field . In addition to working with blood vessels, we intend to anastomose lymphatic vessels and nerves to restore patients ' lost functions, something we have done before at other centers," says Prof. Torres.

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