Chimeric Flaps Achieve Complete Survival in Complex Orbitomaxillary Reconstruction Study

Multicomponent chimeric flaps achieved complete flap survival and satisfactory contour restoration in all eleven patients undergoing primary orbitomaxillary reconstruction for sinonasal malignancy, according to a retrospective observational study conducted by surgical researchers at Tata Medical Center Kolkata. The investigation, published in Frontiers in Oncology, evaluated reconstructive outcomes in consecutive patients presenting with extensive midface defects classified as modified Brown type 3 to 6 maxillectomies treated between June 2024 and April 2026.

Sinonasal malignancies represent rare head and neck tumors that occasionally extend into the orbitomaxillary region, producing severe skeletal and soft-tissue voids upon surgical resection. When ablative surgery permits globe preservation, reconstructive complexity increases substantially because the orbital contents demand rigid structural support to maintain anatomical positioning. The authors note that globe-preserving total maxillectomy defects ideally require vascularized osseous reconstruction capable of providing multivector structural support, necessitating multicomponent flaps whose distinct paddles can be titrated independently to match the intricate three-dimensional anatomy.

The observational study evaluated consecutive surgical candidates at the tertiary referral center over a twenty-two-month period to determine the clinical utility of individualized chimeric flap configurations. Across the eleven-patient cohort, the predominant underlying histological diagnosis was squamous cell carcinoma. Reconstructive strategies were categorized based on whether bony structural framework was incorporated, distinguishing osseous chimeric reconstructions designed for globe-preserving total maxillectomy from soft-tissue chimeric flaps tailored for the remaining orbitomaxillary defect patterns.

Of the eleven surgical interventions analyzed, soft-tissue chimeric flaps comprised seven cases (64 percent), whereas osseous chimeric flaps accounted for four cases (36 percent). To address diverse structural and coverage requirements, the reconstructive repertoire cited in the report encompassed anterolateral thigh, fibula, and scapula chimeric flap designs. For patients receiving osseous reconstruction with globe preservation, surgical teams utilized three-dimensional anatomical models to contour the vascularized bone strut and guided the placement of orbital floor mesh to achieve precise restoration of the orbital boundaries.

Postoperative evaluations focused on objective surgical and oncological milestones, including total flap survival, the necessity of surgical re-explorations, wound healing compromise, and potential delays in initiating adjuvant therapy. In the subgroup of patients managed with orbital preservation, clinical follow-up specifically monitored for complications such as diplopia and enophthalmos. The researchers reported a 100 percent flap survival rate across the series, with all eleven patients achieving satisfactory primary wound healing and contour restoration without flap loss.

The authors concluded that multicomponent chimeric flaps offer sufficient architectural flexibility to achieve reliable primary healing across complex, three-dimensional orbitomaxillary defects. They emphasized that bone reconstruction remains warranted during total maxillectomy when preserving the globe, where combining 3D-modeled bone contouring with orbital floor mesh supports accurate structural restitution.

The research was conducted by corresponding author Karnav Panchal alongside co-authors Kapila Manikantan, Saugata Samadder, P. Arun, Vikram D. Kekatpure, Prateek V. Jain, and Gurucharan Sahu at Tata Medical Center Kolkata. Formally received in August 2026 and accepted in September 2026 for publication in the Head and Neck Cancer section of Frontiers in Oncology, the investigation evaluated consecutive patients presenting with sinonasal malignancy between June 2024 and April 2026.

Subject of Research: Primary orbitomaxillary reconstruction using multicomponent chimeric flaps in sinonasal malignancy

Article Title: Application of chimeric flaps for complex orbitomaxillary reconstruction in sinonasal malignancy

Article References: Panchal, K., Manikantan, K., Samadder, S., Arun, P., Kekatpure, V. D., Jain, P. V., & Sahu, G. (2026). Application of chimeric flaps for complex orbitomaxillary reconstruction in sinonasal malignancy. Frontiers in Oncology, 16, Article 1963043. https://doi.org/10.3389/fonc.2026.1963043

Image Credits: AI Generated

DOI: 10.3389/fonc.2026.1963043

Keywords: sinonasal malignancy, orbitomaxillary reconstruction, chimeric flaps, maxillectomy defects, globe preservation, reconstructive surgery, squamous cell carcinoma, head and neck oncology, Application, chimeric, flaps, complex