Periorbital necrotising fasciitis is an extremely rare and life-threatening condition, often requiring complex reconstructive strategies. The anterolateral thigh (ALT) flap is a fasciocutaneous flap often employed for cancer and trauma reconstruction. We report the successful utilisation of the ALT flap as a single-stage operation for reconstruction of a large tissue defect following extensive debridement and orbital exenteration using the reconstructive elevator as a framework for decision-making. The elderly patient recovered quickly, and the ALT flap provided suitable soft tissue coverage with future plans for elective flap debulking made to improve facial cosmesis.
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