Orbital socket reconstruction using free muscle flaps and dermis fat graft in cases of eyelid- and conjunctiva-sparing exenterations.

We present a novel technique in 3 patients utilizing free musculocutaneous or adipocutaneous flap with or without an overlying dermis fat graft (DFG) for reconstruction of eyelid- and conjunctiva-sparing exenterations. Indications for exenteration included recurrent grade 2 spheno-orbital meningioma in a blind painful eye, a recurrent malignant solitary fibrous tumour, and a chronic nasocutaneous fistula in an anophthalmic socket that had previously undergone radiation and surgical resection for sinonasal orbital lymphoma. Adductor magnus (n = 1) and radial forearm (n = 2) were used for muscle-free flap harvest sites. Two months postoperatively, both DFGs had conjunctivalization of dermis faces, and the patients maintained a traditional ocular prosthesis. In one case, the flap's native dermis face was preserved without the need for a DFG; however, there was socket contraction at postoperative month 21. In eyelid- and conjunctiva-sparing exenteration, reconstruction can be considered with a muscle-free flap and overlying DFG.