Staged anophthalmic socket reconstruction with an expanded forehead island flap pedicled on the superficial temporal artery: a case report

Reconstruction of a severely contracted anophthalmic socket is difficult when both soft-tissue volume and prosthesis retention are inadequate. We report a 26-year-old man with persistent right orbital depression and conjunctival sac stenosis after enucleation for retinoblastoma and subsequent autologous rib orbital plasty. Reconstruction was performed in two stages: a 100 mL forehead tissue expander was expanded to 245 mL over 3.5 months, followed by transfer of a 4 cm × 4 cm expanded forehead island flap based on the superficial temporal artery (STA) and accompanying vein. The flap was passed through a subcutaneous tunnel after scar release. Perfusion was satisfactory, and socket contour and prosthesis retention improved by 1 month. Computed tomography (CT) volumetry at 10 months showed an increase in right orbital volume from 26.99 to 32.33 cm3 (5.34 cm3). Autologous fat grafting to the upper eyelid was performed 1 year after flap transfer to refine the periorbital contour. At 2 years, the patient maintained a favorable clinical appearance and satisfactory prosthetic eye fitting; this later appearance reflects the combined procedures and does not establish long-term volumetric stability of the flap alone. This case demonstrates the technical feasibility of an expanded STA-pedicled forehead flap in a selected patient, while additional cases and longer objective follow-up are required.