Midline Forehead Flap for Coverage of Exposed Exenterated Orbital Wall after Radiotherapy

Purpose: To report a case of exposed exenterated orbital wall after radiotherapy successfully managed by the midline forehead flap. Method: A case report. Result: A 79-year-old female presented with melanoma of the right eyelid and conjunctiva with extension to the orbit. Exenteration was performed and the wound healed by spontaneous granulation. The patient also received postoperative radiotherapy. Seven months after surgery, the patient developed an episode of bone exposure with purulent discharge at the inferior lateral wall of the right orbit. The pathogen was Staphylococcus aureus. Topical fortified antibiotic agents (Vancomycin 50mg/cc, 1gtt, q1h) were prescribed for treatment and bone exposure was improved. However, the patient experienced another three recurrences of erosion with bone exposure at the same area over the next 10-year period. To solve the recurrent erosion with bone exposure, we decided to perform midline forehead flap (MFF) covering in a two-stage operation. No recurrence of tissue necrosis or bone exposure was found during the 67-month follow-up. Conclusion: The use of midline forehead flap to cover the exposed exenterated orbital wall after radiotherapy improved not only the wound healing, but also the aesthetic result.