Simultaneous reconstruction of orbital defect and parotid contour deformity by a single muscle-sparing VRAM flap with double-skin islands

Reconstruction of complex three-dimensional defects or defects in separate locations after ablative head and neck surgery can be achieved with two simultaneous free flaps, a combination of a free flap and a pedicle flap, or a single multi-island free flap. The rectus abdominis flap is often used for reconstructions with a single multi-island free flap, but the flap is excessively bulky in some cases, leading to the unnecessary sacrifice of muscle. To overcome this issue and to preserve the muscle, we used a single muscle-sparing vertical rectus abdominis musculocutaneous flap with two completely separated skin islands based on two different skin perforators to simultaneously reconstruct separate locations (the orbit and parotid region) after orbital exenteration and total parotidectomy. Our findings highlight the feasibility of simultaneously reconstructing orbit and parotid contour deformities with a single double-island flap.