Upper eyelid reconstruction using a combination of a nasal septal chondromucosal graft and a Fricke flap: a case report

Sebaceous carcinoma is a malignant neoplasm that usually arises in the sebaceous glands of the eyelids. Its pathogenesis is unknown; however, irradiation history, immunosuppression, and use of diuretics are known risk factors. The mainstay of treatment for sebaceous carcinoma of the eyelid is wide surgical resection with a safety margin of 5 to 6 mm, which often results in full-thickness defects. The reconstruction of a full-thickness defect of the eyelid should be approached using a three-lamella method: a mucosal component replacing the conjunctiva, a cartilage component for the tarsal plate, and a flap or skin graft for the skin of the eyelid. In this case, a fullthickness defect of the upper eyelid was reconstructed after tumor removal using a combination of a nasal septum chondromucosal composite graft and a forehead transposition flap, also known as a “Fricke flap.” The flap was designed to include a line of the eyebrow on the lower margin of the flap to replace the eyelash removed during tumor excision. The wound healed completely, without any early or late complications, and the outcome was satisfactory.

Lower eyelid fornix deepening: A new indication for the facial artery myomucosal flap

Eye socket contracture is a well-known late complication of enucleation surgery, and the additional insult of radiotherapy at an early age causes even further fibrosis and scarring of the socket. Management of the contracted socket is challenging, and several methods have been proposed. We report a case of eye socket contracture after enucleation and radiotherapy in which multiple reconstructive procedures failed. The recurrent contracture caused difficulty in housing and retaining the eye prosthesis. We reconstructed the lower eyelid with a facial artery myomucosal flap and nasolabial flap, and the upper eyelid with a Fricke flap following reconstruction of the orbital rims (supraorbital and infraorbital rims with a calvarial bone graft, and further augmentation of the infraorbital rim with a rib bone graft). Cosmesis post-reconstruction was acceptable and the prosthesis was retained very well.

Functional and Aesthetic Outcomes of Fricke flap in Periorbital Reconstruction – A Retrospective Study

The reconstruction of the periorbital tissue defects is often challenging due to its complex anatomy. A wide variety of reconstruction options were implemented based upon aesthetic unit, type of defect and skill of surgeon. Fricke flap is a laterally based monopedicled flap used to reconstruct eyelid and periorbital defects. The study evaluates the aesthetic and functional outcome of Fricke flap in patients who underwent periorbital reconstruction at Saveetha Medical College & Hospital. The post-operative record of 20 patients with lateral periorbital defect treated with Fricke flap were analyzed to grade the outcome. 70% of the patients had history of immediate trauma. The primary management after debridement with Fricke flap yields better esthetic (70%) and functional outcome (90%). Case illustration of two patients have been provided who underwent immediate periorbital reconstruction post soft tissue injury due to RTA. The study was conclusive of Fricke flap as a valuable and simple model in periorbital reconstruction.

Reconstruction of Combined Full-Thickness Defect of the Lateral Canthus and Lateral Upper and Lower Third Eyelids With an Extended Modification of the Fricke Flap, Periosteal Flap, and Conjunctival Flap

Introduction: The Fricke flap was originally described in 1829 as a laterally based flap from the temporal region that could be used to reconstruct potentially total lower eyelid defects. There have been a few minor modifications of this flap to allow for adjustments of the donor site scar, but none that address the sequelae of brow elevation and allow for reconstruction of a composite defect of the lateral canthus, lateral upper, and lower eyelids. We report our modification of the Fricke flap that allows for total reconstruction of these structures. Clinical Report: A 61-year-old male presented with composite defect of the lateral eyelids and canthus following resection of a basal cell carcinoma by Mohs technique. A Fricke flap was designed and modified to included elements of the above brow and below brow skin as an additional pennant flap. A “Y” shaped periosteal flap and inferior fornix conjunctival flap were also used to reconstruct the posterior lamella. Our surgical technique and follow-up are demonstrated. Discussion: Lateral eyelid and canthal reconstruction can be difficult to reconstruct with a single rotational flap from local sources. We describe our technique of modifying the Fricke flap to include an additional pennant of below brow skin that can be used to reconstruct the lateral eyelids and canthus allowing for a crisp lateral eyelid crease and acceptable donor site and aesthetic appearance. Conclusions: This is the first description of a modification of the Fricke flap that allows for total lateral eyelid and canthus reconstruction.