Eyelids and eye socket reconstruction using the expanded forehead flap and scapha composite grafting

Area of Science:

• Plastic Surgery
• Ophthalmology
• Reconstructive Surgery

Background:

• Reconstruction of eyelids and eye sockets following trauma or malignant tumor excision presents significant challenges in achieving satisfactory aesthetic and functional outcomes for ocular prosthesis.
• Existing methods often struggle to provide adequate soft-tissue support and contour for prosthetic eyes.

Observation:

• A three-step surgical procedure was developed, focusing on the reconstruction of the eye socket, eyelids, and tarsus/eyelid margin.
• The expanded forehead flap, alone or in combination with a galea flap or free rectus abdominis muscle perforator flap, was utilized due to its vascularity and reconstructive versatility.
• The scapha composite graft was employed for tarsus and eyelid margin reconstruction, overcoming limitations of traditional cartilage grafts.

Findings:

• The expanded forehead flap provided sufficient tissue volume for the eye socket, creating a deep, convex fornix for improved ocular prosthesis fit and stability.
• This flap also yielded excellent thin upper eyelid contour and good color matching.
• The scapha composite graft resulted in a natural shape and good elasticity for the tarsus and eyelid margin reconstruction.

Implications:

• This surgical approach offers a reliable method for successful reconstruction of the anophthalmic socket and eyelids, enhancing prosthetic eye stability and aesthetics.
• The technique addresses limitations of previous methods, potentially improving patient quality of life after major facial trauma or oncological resection.
• The use of expanded forehead flaps and scapha composite grafts represents an advancement in reconstructive surgery for complex orbital defects.