Eyelid reconstruction with radial free forearm flap: functional and esthetic outcomes

Periorbital defects resulting from oncologic resections, trauma, or congenital malformations pose a complex reconstructive challenge, due to the need to simultaneously restore eyelid function and facial esthetics. We present the case of a male patient in his seventh decade of life with a right orbitomalar squamous cell carcinoma, who underwent a wide oncologic resection involving the upper and lower eyelids, as well as the malar and infraorbital regions. Reconstruction was performed using a radial free forearm flap from the left arm, including the palmaris longus tendon, which was strategically anchored to the medial canthus and orbital rim to provide dynamic eyelid support. This technique allowed for satisfactory anatomical and functional restoration. The microvascular radial forearm flap stands out for its thinness, pliability, and reliable vascularity, making it a suitable alternative to bulkier flaps such as the anterolateral thigh flap, particularly in the reconstruction of extensive and anatomically complex defects.