title: An oculoplastic use for the temporalis muscle flap.
abstract: OBJECTIVE
  To report a novel method of repairing a large periorbital defect with exposed bone, using a pedicled temporalis muscle flap and split thickness skin graft.
  
  
  METHODS
  Interventional case note review with clinical photographs, computerised tomography (CT) imaging, intra-operative photographs and histology.
  
  
  RESULTS
  A 77-year-old man presented with an extensive neglected ulcerating lesion extending from the left lateral canthus to the tragus of the left ear. An incisional biopsy of the 15 cm lesion confirmed the clinical diagnosis of an invasive squamous cell carcinoma. A CT scan demonstrated the tumour depth and there were no infra-temporal fossa or intra-orbital extensions or associated lymphadenopathy. A wide surgical excision was performed which resulted perioperatively in a large area of exposed zygomatic and temporal bone. A pedicled temporalis muscle flap was rotated to cover the exposed bone and therefore allow placement of a split thickness skin graft. At 3 months' follow-up the graft is viable and the surgical rehabilitative result is satisfactory.
  
  
  CONCLUSIONS
  A pedicled temporalis muscle flap and split thickness skin graft is a good one-stage reconstruction technique when faced with a large area of exposed bone. The temporalis muscle provides a suitable recipient site for a split skin graft and enhances its chances of survival. This technique, to our knowledge, had not previously been reported in the literature.
authors.affiliation: Academic Clinician Fellow and Specialist, Registrar in Ophthalmology, Faculty of Life Sciences, University of Manchester and Academic Department of Ophthalmology, Manchester Royal Eye Hospital, Manchester, UK. jasminac@doctors.org.uk
authors.forename: Jasmina
authors.initials: J
authors.lastname: Cehajic
authors.forename: Andrew
authors.initials: A
authors.lastname: Moody
authors.forename: Richard C W
authors.initials: RC
authors.lastname: James
authors.forename: Gill
authors.initials: G
authors.lastname: Watson
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Wearne
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D005145:Face; D006801:Humans; D008297:Male; D012878:Skin Neoplasms / Q000601:surgery*; D016038:Skin Transplantation; D012883:Skin Ulcer / Q000601:surgery*; D013524:Surgical Flaps