Pericranial Flaps and Grafts for Oculoplastic Reconstructive Surgery: A Major Review

The pericranium, a component often overlooked in oculoplastic surgery, is a rich source of reconstructive potential. While it is frequently used in craniofacial surgery, pericranial flaps and grafts are generally underutilized in oculoplastics, with limited published research. This review aims to highlight its anatomy, surgical dissection techniques, and versatile benefits to inspire and motivate the oculoplastic community to widen its application in reconstructive surgery.

A literature review of all cases published in oculoplastic surgery using pericranial flaps.

The anatomy, operative dissection methods, and all published applications of pericranial flaps and free grafts in oculoplastic surgery are described. Vascularized flaps have been used to reconstruct eyelid and orbital defects, frontal-orbital mucoceles, and orbital-sinus fistulas. Free pericranial grafts are less frequently reported in oculoplastic literature, as they are primarily used in conjunction with a vascularized cutaneous flap for eyelid defects, but may also be used alone in the repair of forniceal contraction or cases of implant exposure.

This review underscores the significant potential of pericranial tissue for oculoplastic reconstruction. Its advantages over existing autologous reconstructive tissues, including maintaining the integrity of overlying skin and soft tissue, rich vascularity, and convenient proximity to periocular and facial defects, make it a promising option for eyelid reconstruction. While isolating the flap may be technically challenging, pericranial flaps and grafts can significantly improve functional and cosmetic outcomes in oculoplastic reconstruction.