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

Abstract

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.

Temporoparietal Fascia Flap for Complex Eyelid Reconstruction: A Case Series and Literature Review

“…A nasal chondromucosal graft may have less donor site morbidity as the donor site can be covered with a buccal mucous membrane graft. 34 An auricular cartilage graft is devoid of mucous membrane and would require a conjunctival flap to cover the ocular side in the upper eyelid to protect the cornea from abrasion. This can be accomplished by sandwiching it in a Cutler-Beard flap or raising a conjunctival flap from the lower lid inferior fornix 35 as was done in case # 4.…”

Clinical association between serum cholesterol level and the size of xanthelasma palpebrarum

“…In this study, surgical excision was performed in all xanthelasma patients. Since the eyelids are the important structure that protects and lubricates the globes and cornea, it is essential to preserve their structure [ 9 , 10 ]. In most cases, simple excision followed by primary closure was enough.…”

Surgical Strategies for Eyelid Defect Reconstruction: A Review on Principles and Techniques

“…5 ). It is particularly useful when the defect involves the entire lower eyelid but with a relatively short height [ 32 ]. However, this two-stage operation may injure the frontal branch of the facial nerve and often result in eyebrow level elevation, upper eyelid malposition, and even lagophthalmos, which requires additional tissue recruitment for correction to prevent exposure keratitis [ 33 ].…”

“…The nasal chondromucosal grafts harvested from the nasal septum [ 32 , 60 – 62 ] or ala [ 63 , 64 ] can offer both support and lining for replacing the tarsus and conjunctiva. The septal mucochondral graft tends to curl toward the mucosa-covered side after thinning of the cartilage, which matches the shape of the tarsus and can provide good eyelid stability and aesthetic outcomes [ 65 , 66 ].…”