Cost-effective reconstruction of long-standing lateral orbital rim defect with bone-prelaminated forehead flap using iliac crest: A case report
Abstract
Rationale: 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.
Patient concerns: 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.
Diagnoses: Infected exposed alloplastic reconstruction with an anophthalmic right orbital deformity and composite lateral orbital rim, temporal, and soft tissue loss.
Interventions: 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.…
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Evidence Hub reads this as a case report, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
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