Upper and lower eyelid reconstruction with a neurovascular free flap from the first web space of the foot.

After orbital exenteration for neoplasia the remaining bony socket is usually lined with skin and the deformity covered with a prosthesis; in many cases this is acceptable to the patient. However, in certain circumstances, especially in younger patients, a request for some form of reconstruction is made. In the past this has involved multistaged local or distant flaps, lined by skin grafts (Meyer, 1971; Carraway et al., 1976) and usually leaves extensive scarring around the orbit. The use of a neurovascular free flap from the first web space of the foot to reconstruct eyelids after exenteration has not to the best of our knowledge been done before. A 23-year-old man had an orbital exenteration carried out IO years previously for a rhabdomyosarcoma. The bony socket had been lined with a split skin graft (Fig. I). He had found an external prosthesis unacceptable and preferred to wear a black eye patch. A free neurovascular flap from the first web space of the foot had previously been described for hand repairs (May et al., 1977) and it occurred to us that it might be used to reconstruct eyelids. The operation was carried out in January 1978.