Total lower-eyelid reconstruction: Modified Fricke's cheek flap

Department of Surgery, Instituto Dermatológico de Jalisco Dr. José Barba Rubio Secretaria de Salud Jalisco, Guadalajara, Mexico.
Journal of Plastic Reconstructive & Aesthetic Surgery (Impact Factor: 1.42). 07/2011; 64(11):1430-5. DOI: 10.1016/j.bjps.2011.06.044
Source: PubMed


The present work reviews a total lower-eyelid reconstruction technique that is currently not widely in use but which, in some cases, has proven to be of great utility in the field of reconstructive plastic surgery of the palpebral area. We performed an observational, longitudinal, descriptive and retrospective follow-up study. A total of 34 cases of non-melanoma skin cancer in which the lower eyelid was completely reconstructed using one flap taken from the cheek (modified Fricke's cheek flap) were reviewed. The follow-up time for the patients ranged from several months to 5 years. Analysis was performed using the Pearson's chi-square statistical test in an effort to examine the association between the technique's range of functionality and aesthetic variables. Results were considered significant with a p<0.05. The functional result was regular for 91.2%, poor for 8.8% and excellent for 0% (p<0.05). The aesthetic result was regular for 88.2%, poor for 11.8% and excellent for 0% (p<0.05). The main complications were scleral exposure and temporary ocular chemosis. Fricke's lower cheek flap is an easy-to-perform, important and often-necessary technique that, in some cases, has yielded positive functional and aesthetic results. This procedure is performed on an outpatient basis and is optimal for aged patients who present with skin cancer and who require total lower-eyelid reconstruction. The use of this technique is associated with a low complication rate and low morbidity.

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Available from: Ronell Eduardo Bologna-Molina, Dec 08, 2015
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    • "There are different techniques for total or partial lower eyelid reconstruction. In his case series on reconstruction of lower eyelids, Barba-Gómez et al.,[3] have considered many such techniques like the method described by Mustarde,[2] the Hughes[4] transposition flap with its modifications,[5] the eyelid[6] cutaneous rim graft, the hard palate graft covered by an orbicularis oculi myocutaneous advancement flap,[7] the Tripier[8] flap, and more complex approaches such as the pre-expansion mucosa-lined tongue flap,[9] the use of acellular human dermis,[1011] the cheek flap supported by fascia lata,[12] the island tarsoconjuctival mucochondrocutaneous flap,[1314] and the use of an expanded forehead Fricke flap.[151617] All of these techniques are useful when reconstruction of the lower eyelid is required; however, some of these procedures are complex and expensive. "
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    ABSTRACT: Cheek defects are common facial defects, especially after tumor ablation. Although primary repair yields the best aesthetic outcome, wide defects require flap resurfacing. Among the flap techniques, the cervicofacial rotation/advancement flap is one of the most common. In cases with eyelid involvement, it is very unlikely that a local flap would single-handedly resurface the defect and additional flaps must be used.This article presents our clinical experience with 14 patients with cheek defects for whom cervicofacial rotation/advancement flaps were used. In 3 of the 14 patients, local flaps that include the laterally based Tripier flap, the Fricke flap, the nasojugal flap, and the median forehead flap were combined with the cervicofacial flap to reconstruct the lower eyelid defects in accordance with the principle of individually reconstructing different anatomic subunits. All infraorbital defects were resurfaced with residual cheek and cervical skin with a good color and texture match. In patients whose eyelids were intact, no malposition was observed.Posteriorly based cervicofacial rotation/advancement flaps offer a very reliable and convenient method for resurfacing infraorbital and medial cheek defects. When a lower eyelid defect is also present, its individual reconstruction as a separate facial subunit needs to be considered using a combination of smaller local flaps.
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