Combined scalp rotation and temporalis muscle flap for orbital exenteration reconstruction

PURPOSE: The scalp rotation flap is a reliable reconstructive technique for large soft tissue scalp defects. As such, it may be of utility in the reconstruction of orbital exenteration defects. The purpose of this study was to describe the use of the scalp rotation flap in combination with a temporalis regional flap for the reconstruction of orbital exenteration defects. METHODS: Technique description and a multi-centre, retrospective case-series of four patients who presented with orbital invasive recurrent malignancies requiring orbital exenteration between January 2018 and May 2025 were performed. All patients underwent reconstruction using a combined temporalis muscle and scalp rotation flap. RESULTS: The exenteration and scalp flap margins were marked out pre-operatively. Following exenteration, the scalp flap was raised in the pre-pericranial plane. Following temporalis flap insertion, the scalp rotation flap was overlayed. Tailoring of the scalp flap was performed to cover the defect. One patient developed a hematoma post-operatively that was managed conservatively. All patients were discharged between 3 and 5 days post-operatively. All patients' surgical and donor sites healed well by 2 weeks post-operatively with acceptable cosmesis. Two patients underwent adjuvant radiation therapy during follow-up with resultant mild dermatitis. No wound complications including flap necrosis or contracture were reported. CONCLUSIONS: The scalp rotation flap may be an effective loco-regional option that can be used in conjunction with the temporalis muscle flap for reconstructing orbital exenteration defects.