Infraorbital and zygomatic reconstruction using pre-expanded rotation flap based on the orbicularis oculi muscle

Infraorbital and zygomatic reconstruction procedures pose challenges to plastic surgeons because of the close location of the operation to the eyes and nose. Failed flap design can lead to distortion of the adjacent organs and tissue, particularly for larger defects. Flaps based on the orbicularis oculi muscle (OOM) can be easily rotated from the lateral or temporal region to cover the infraorbital and zygomatic area. We use a soft-tissue expander to enlarge the size of this flap for larger defect repair. Out of a total of 12 patients whose infraorbital or zygomatic defects ranged from 2.0 × 3.0 cm to 4.0 × 5.0 cm, 11 experienced a successful repair without complications. The size of the pre-expanded rotation flap ranged from 3.0 × 4.0 cm to 5.0 × 7.0 cm. The pre-expanded rotation flap based on the OOM has the advantages of an excellent colour and thickness match to the infraorbital and zygomatic areas, a reliable blood supply, abundant tissue and negligible donor-site morbidity. It has thus become our favourite technique for infraorbital and zygomatic reconstruction.