We will be addressing orbital osteomyelitis that has occurred after orbital exenteration and radiation.  Initially, osteocutaneous radial forearm free flap was placed into the orbital cavity and to reconstruct the medial buttress.  After radiation, aberrant communication had formed between the orbital cavity that was draped with radial forearm skin and the nasal cavity. Eventually, radial forearm skin broke down with a formation of a fistula and there were signs of osteomyelitis along the orbital cavity involving both the orbital apex and orbital roof.

Procedures:

1. Bicoronal Incision approach to orbit
2. Debridement of orbital bone
3. Contralateral pericranial flap harvest
4. Ipsilateral Temporalis muscle flap harvest
5. Creation of bonny tunnel through posterior orbital wall
6. Pericranial flap and temporalis flap inset
7. Composite abdominal fat harvest for temporalis muscle donor site
8. Skin graft

This is a Beta version to expedite release due to a member’s request.  We will eventually edit this to the standard editing quality at a later time.