Orbital exenteration is an extremely mutilating procedure for patients, and reconstruction is mandatory in most cases. The inverted cone shape of the exenterated orbit poses a significant challenge for reconstructive surgeons and anaplastologists, who must collaborate closely to achieve a satisfactory outcome that enables patients to reintegrate social life more easily.

This systematic review followed the 2020 PRISMA guidelines and its protocol was pre-registered in PROSPERO (ID: CRD420251149891). The study focuses on the latest flap design strategies aimed at meeting the complex geometric requirements inherent to reconstruction of this region. Eleven 11 studies were selected among the PubMed and Google Scholar databases presenting genuine innovations in flap conformation for orbital exenteration reconstruction. A total of 64 patients were included, with a reevaluation of both pedicled and free flap techniques, including the temporalis muscle flap, galeal flap, forehead flap, radial forearm free flap, and flaps based on the lateral circumflex femoral artery system.

These techniques show promise, with a combined prosthetic rehabilitation rate of 50 %. By synthesizing contemporary surgical methods and highlighting novel approaches, this review provides reconstructive surgeons with an updated framework for planning orbital exenteration reconstruction that restores both form and function, ultimately improving patient quality of life.