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imageBackground: Among the reconstructive options after orbital exenteration, the temporalis myofascial flap (TMF) has been widely recognized as the one of the best available solutions. We think that the hemicoronal approach to harvest the TMF represents a disadvantage so we adopted a modified approach that we named the anterior retrograde approach to the TMF.
Methods: Nine patients with malignant orbital tumors underwent orbital exenteration and primary reconstruction with TMF harvested with the anterior retrograde approach. The temporalis muscle was widely exposed through the anterior incision used to perform the orbital exenteration. The harvested flap was then rotated and insetted to fill the orbital cavity.
Results: Neither cases of total/partial flap failure nor local/regional recurrence of tumor were recorded. The technique showed a significant reduction of morbidity, surgical time, and blood loss compared with the traditional technique.
Conclusions: We think that the anterior retrograde approach should be considered as a valid alternative to the traditional hemicoronal approach.

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