Iberoamerican Journal of Medicine
Iberoamerican Journal of Medicine
Case Report

Post-Exenteration Orbital Wall Reconstruction With Paramedian Forehead Flap

Mior Faiq Mior Abu Tahrin, Che Jamal Abdillah Che Aman, Nur Shazwani Farah Md. Mydin Siddik

Downloads: 1
Views: 526


Orbital exenteration is a mutilating surgery that involves the total removal of the orbital contents with partial or total excision of the eyelids. It is usually associated with an extremely disfiguring cosmetic outcome which requires some degree of reconstruction before an artificial eye can be placed into the socket. Often times, the orbital cavity needs to be filled with a soft tissue cover especially if the orbital fissures and optic canal is exposed. Free tissue transfer is thought to be the best option in reconstructing complex defect. However, some conditions do not permit a free flap reconstruction to be performed like in a previously irradiated bed as it increases the risk of vascular complications. We present a case of post orbital exenteration who is not suitable for a free flap and wound coverage was done with a paramedian forehead flap as an alternative.


Orbital wall defect; Paramedian forehead flap; Soft tissue reconstruction


1. Bengtson BP, Schusterman MA, Baldwin BJ, Miller MJ, Reece GP, Kroll SS, et al. Influence of prior radiotherapy on the development of postoperative complications and success of free tissue transfers in head and neck cancer reconstruction. Am J Surg. 1993;166:326Y330. doi: 10.1016/S0002-9610(05)80325-3.
2. Halle M, Farnebo F. Does previous head and neck irradiation increase vascular complications in free autologous reconstruction? Plast Reconstr Surg. 2012;129:549eY550e; author reply 550e. doi: 10.1097/PRS.0b013e318241997a.
3. Fosnot J, Fischer JP, Smartt JM Jr, Low DW, Kovach SJ, et al. Does previous chest wall irradiation increase vascular complications in free autologous breast reconstruction? Plast Reconstr Surg. 2011;127:496Y504. doi: 10.1097/PRS.0b013e3181fed560.
4. Kroll SS, Robb GL, Reece GP, Miller MJ, Evans GR Baldwin BJ. et al. Does prior irradiation increase the risk of total or partial free-flap loss? J Reconstr Microsurg. 1998;14:263Y268. doi: 10.1055/s-2007-1000179.
5. Sugihara T, Hattori Y, Yamamoto Y, Qi F, Ichikawa R, Sato A, et al. Preferential impairment of nitric oxide-mediated endothelium-dependent relaxation in human cervical arteries after irradiation. Circulation. 1999;100:635Y641. doi:10.1161/01.CIR.100.6.635.
6. Tall J, Björklund TC, Skogh AC, Arnander C, Halle M. Vascular complications after radiotherapy in head and neck free flap reconstruction: clinical outcome related to vascular biology. Ann Plast Surg. 2015;75(3):309-15. doi: 10.1097/SAP.0000000000000081.
7. Ratner D. Skin grafting from here to there. Dermatol Clin. 1998;16:75-90.doi: 10.1016/S0733-8635(05)70488-5.
8. Kazanjian VH. The repair of nasal defects with the median forehead flap: primary closure of the forehead wound. Surg Gynecol Obstet. 1946;83:37-42.
9. Price DL, Sherris DA, Bartley GB, Garrity JA. Forehead flap periorbital reconstruction. Arch Facial Plast Surg. 2004;6(4):222-7. doi:10.1001/archfaci.6.4.222.

Submitted date:

Reviewed date:

Accepted date:

Publication date:

5ddceefd0e882541121da3e9 iberoamericanjm Articles
Links & Downloads

Iberoam J Med

Share this page
Page Sections