A case report of reconstruction of ocular and complete upper eyelid avulsion with severe facial soft tissue injuries using anterolateral thigh free flap

Introduction and importance: Ocular injury is second mostly caused by motor vehicle accident (MVA) and often leads to severe ocular injury even to visual loss and various aesthetic problems. The outcome is determined by the magnitude of the initial damage and treatment availability. Treating ocular and facial injury due to MVA is challenging given the scope of the damage and may result in various outcomes.

Case presentation: This case presented a 22-years old woman with a history of car accident assessed with total upper eyelid avulsion with corneal perforation and involvement of multiple facial fractures on the left side. The visual function is irreparable due to the extensive corneal defect from exposure and secondary infection, and possible optic nerve damage.

Clinical discussion: This case presented a complete upper eyelid avulsion with severe facial tissue injury. Therefore, the reconstructive procedure main objectives are to maintain appropriate prosthetic position and to improve cosmetic function. This case used anterolateral thigh free flap as the reconstructive surgery method because it is convenient for large defects and the donor scar is not visible. After completing the surgery and several follow-up procedures, the patient recovered without any significant complications.

Conclusion: Despite visual loss due to the extent damage of the eye, it is important to restore the facial damages. Visual function is as crucial as cosmetic function in determining the patient's quality of life.