Complex reconstruction of the orbitofrontal regions using three regional flaps after orbital exenteration for the treatment of basal cell carcinoma

Abstract

Objective. The current paper presents an interesting case of facial reconstruction after the excision of a giant basal cell carcinoma located in the orbitofrontal region. Methods. Performing the excision while securing the appropriate oncologic safety margin has determined the appearance of a soft tissue defect that required a complex reconstruction using three regional flaps: frontal, temporal fascial and temporal muscle flaps. Results. After the excision and reconstruction in a single surgical stage, the postoperative result was favorable, the 12 months assessment showing that the patient was satisfied with the aesthetic aspect. Conclusion.Including the orbital exenterations in the excisional treatment of giant neoplasms located in the facial region requires a complex reconstructive plan. The surgical team has to consider the relief of the anatomical structures that are targeted, as well as the necessity of achieving satisfactory aesthetic results while ensuring oncological radicality.

Reconstructive options following orbital exenteration

“…These flaps have a dependable blood supply, large degree of rotation, and minimal donor site morbidity. Multiple studies have demonstrated the TPFF as a reliable flap for reconstructing an exenterated cavity [1,5] . For larger resections involving significant surrounding soft tissue, especially in the setting of periorbital skin cancers, free tissue transfer is often necessary for adequate reconstruction.…”

Reconstruction of lower eyelid defects after the excision of basal cell carcinoma

“…Generally, eyelid reconstruction must respect two principles: first and foremost, the functional principle, of protecting the eye, and secondly, the aesthetic principle [ 4 ]. The upper eyelid must be mobile, dynamic, in order to ease the sight and eye opening and, at the same time, to ease closing the eye and protect the cornea.…”