# Hard Palate Graft Combined with Fricke Flap: Satisfactory Option for Reconstruction of Extensive Lower Eyelid Defects—A Case Series

## TL;DR

This study shows that combining a hard palate graft with a Fricke flap is effective for reconstructing large lower eyelid defects with good results.

## Contribution

The paper introduces a single-stage surgical technique combining a hard palate graft and Fricke flap for lower eyelid reconstruction.

## Key findings

- Seven patients had successful lower eyelid reconstructions with no cancer recurrence after 2 years.
- The technique had low morbidity and short operative times, with satisfactory aesthetic and functional outcomes.
- Only one patient experienced a complication (ectropion) due to a retracting scar.

## Abstract

Background: The reconstruction of extensive full-thickness lower eyelid defects constitutes a challenge for plastic surgeons. Various techniques have been described to cater to patients’ specific defect needs, with the aim of achieving the best results. Materials and Methods: We performed a retrospective observational study assessing our experience with a combination of a single-stage procedure consisting of a hard palate graft and a Fricke flap for patients with complex lower lid resections undergoing immediate total reconstruction at our institution. Clinical data, histological type and results, size of tumor, recurrences, and post-operative complications were collected to evaluate outcomes. A Visual Analogue 10-point scale was administered to all patients to assess esthetic and functional outcomes. Results: Seven lower lid reconstructions were performed, with all patients receiving immediate reconstruction. The age of the patients ranged from 55 to 82. Five skin cancers were located on the right side and three on the left side. In all cases, histological diagnosis was non-melanoma skin cancers. The mean size of the tumor was 1.7 × 1.7. In all patients, negative surgical margins were obtained. All patients underwent 24-month follow up. No immediate complication from surgery was recorded within the first 30 days. During follow-up, lower lid ectropion was observed in one patient due to the development of a retracting scar. No local cancer recurrence or nodal metastasis were detected until 2 years follow-up. In only one case, adjuvant therapy was required. The aesthetic results were deemed satisfactory by all patients. Conclusions: According to our experience, the combination of a Fricke flap and hard palate graft is an excellent option for total lower eyelid reconstruction, with low morbidity and favorable outcomes, even in elderly and frail patients where satisfactory results were achieved in a single-stage procedure and short operative times.