Cost-effective reconstruction of long-standing lateral orbital rim defect with bone-prelaminated forehead flap using...

Reconstructing composite lateral orbital rim defects after high-energy trauma remains challenging, particularly after infected alloplastic failure and in settings where microsurgery or patient-specific implants are unavailable. Autologous regional reconstruction may restore soft tissue coverage and bony support while avoiding additional hardware.

A 33-year-old man presented with a long-standing post-traumatic right orbital deformity after ballistic injury, including globe loss and composite defects of the lateral orbital rim, temporal bone, and adjacent soft tissues. A previously placed metallic mesh had become exposed and infected, causing pain, deformity, and an inability to proceed with prosthetic rehabilitation.

Infected exposed alloplastic reconstruction with an anophthalmic right orbital deformity and composite lateral orbital rim, temporal, and soft tissue loss.

Management was staged. After mesh removal, culture-directed infection control, crane flap preparation, delayed transfer, supragaleal retrieval, and split-thickness skin grafting, definitive repair was performed using a contralateral forehead flap measuring 6 cm × 6 cm with a 12-cm pedicle, prelaminated with an iliac crest bone graft in a narrow distal subcutaneous pocket. The flap reconstructed the lateral orbital rim, and lateral canthal support was restored using nylon loop-suture suspension anchored through the graft, without rigid alloplastic hardware.

Distal venous congestion resolved after superficial suture release and leech therapy, without necrosis. Early imaging confirmed stable graft positioning, and the socket was anatomically suitable for future ocular prosthesis placement; however, prosthetic fitting had not yet been completed.

This technique may represent a cost-conscious option in resource-limited settings, but longer follow-up is needed.