Reconstruction of the upper eyelid ciliary margin using an eyebrow hair-bearing Fricke flap in a young patient: a case report

Sushma Reddy; Madhubari Vathulya; Tasvir Balar; Vinita Gupta

doi:10.18203/2349-2902.isj20263371

Authors

Sushma Reddy Department of Plastic Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India https://orcid.org/0009-0001-5623-6915
Madhubari Vathulya Department of Plastic Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India https://orcid.org/0000-0002-7050-5990
Tasvir Balar Department of Plastic Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India https://orcid.org/0009-0005-6673-8870
Vinita Gupta Department of Opthalmology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India https://orcid.org/0000-0002-7118-2329

DOI:

https://doi.org/10.18203/2349-2902.isj20263371

Keywords:

Upper eyelid trauma, Fricke flap, Eyelid reconstruction with lashes reconstruction, Forehead flap, Oculoplastic surgery, Eyelid aesthetics

Abstract

Traumatic loss of upper eyelid tissue presents a dual challenge—restoring the delicate mechanics of eyelid function while recreating the subtle aesthetic harmony of the periocular region. We report the reconstruction of a lateral upper eyelid defect in an 18-year-old male following traumatic avulsion, approached with an emphasis on both protection and appearance. A temporally based forehead (Fricke) flap was thoughtfully designed to incorporate a linear array of eyebrow hair follicles, allowing not only resurfacing of the defect but also recreation of a natural-appearing lash line. This was complemented by meticulous posterior lamellar repair and lateral canthal stabilization for structural integrity. This reconstruction achieved stable eyelid position, complete and comfortable eye closure, and pleasing aesthetic contour with restoration of the lash margin. This case highlights the versatility of the Fricke flap, demonstrating how, when adapted with aesthetic intent, it can seamlessly unite function with form in selected traumatic eyelid defects.

References

Jennings E, Krakauer M, Nunery WR, Aakalu VK. Advancements in the repair of large upper eyelid defects: a 10-year review. Orbit. 2021;40(6):470-80.

Yan Y, Fu R, Ji Q, Liu C, Yang J, Yin X, et al. Surgical strategies for eyelid defect reconstruction: a review on principles and techniques. Ophthalmol Ther. 2022;11(4):1383-1408.

Gillipelli SR, Quirarte DM, Owens WR, Parham MJ, Jiang AY, Williams KJ, et al. Eyelid reconstruction. Semin Plast Surg. 2024;38(4):279-89.

Lee JH, Woo SS, Shin SH, Kim HJ, Kim JH, Kim SH, et al. Upper eyelid reconstruction using a combination of a nasal septal chondromucosal graft and a Fricke flap: a case report. Arch Craniofac Surg. 2021;22(4):204-8.

Kasai K. Eyelash reconstruction with strip composite eyebrow graft. Ann Plast Surg. 2008;60(6):649-51.

Kadaba V, Ghosh Y. Reconstruction of a large lateral upper and lower eyelid defect using a Mitek screw, Fricke flap and skin grafts from the eyelid. BMJ Case Rep. 2024;17(12):e258714.

Gillipelli SR, Quirarte DM, Owens WR, Parham MJ, Jiang AY, Williams KJ, et al. Eyelid reconstruction. Semin Plast Surg. 2024;38(4):279-89.

Vathulya M, Chattopadhyay D, Koyama K. Olympic torch flap: one-stop option for simultaneous brow, upper and lower lid reconstruction in post burn patients. Ann Burns Fire Disasters. 2017;30(2):143-5.

Mukit M, Anbar F, Dadireddy K, Konofaos P. Eyelid reconstruction: an algorithm based on defect location. J Craniofac Surg. 2022;33(3):821-6.

Wilcsek G, Leatherbarrow B, Halliwell M, Francis I. The 'RITE' use of the Fricke flap in periorbital reconstruction. Eye (Lond). 2005;19(8):854-60.