Reconstruction after extended orbital exenteration using a fronto-lateral flap

Abstract

Orbital exanteration is usually performed for advanced neoplasms of the eyelids and is associated with significant distress for patients. Its reconstruction should aim for functional and aesthetic results and safety for further oncological treatment. The ideal reconstruction should provide adequate cutaneous covering, short healing time, obliteration and closure of communication with facial sinuses and nasal cavity, resistance to radiotherapy, low morbidity and favorable rehabilitation. In 10 patients, a flap based on the frontal branch of the temporal artery was used for immediate reconstruction after orbital exenteration. Flap demarcation began through the frontal midline from the glabella to 0.5 cm above the hairline. Its elevation was performed in a plane above the periosteum and galea, including skin, subcutaneous tissue and frontal muscle. It was rotated tension-free over the defect. In all patients, adequate closure of the defect and obliteration of the orbital cavity was achieved. There was no flap loss or major complications. The lateral frontal flap is easy and fast to execute, with a reliable blood supply and reproducible technique. Its main applicability is for patients with orbital defects and high surgical risks with contraindications for microsurgical reconstruction.