{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T16:47:21Z","timestamp":1787503641844,"version":"build-2736575974"},"reference-count":35,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,4,7]],"date-time":"2025-04-07T00:00:00Z","timestamp":1743984000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Italian Ministry of Health","award":["ISG 2025"],"award-info":[{"award-number":["ISG 2025"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>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\u2019 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 \u00d7 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.<\/jats:p>","DOI":"10.3390\/jcm14072503","type":"journal-article","created":{"date-parts":[[2025,4,7]],"date-time":"2025-04-07T10:06:28Z","timestamp":1744020388000},"page":"2503","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Hard Palate Graft Combined with Fricke Flap: Satisfactory Option for Reconstruction of Extensive Lower Eyelid Defects\u2014A Case Series"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2639-2957","authenticated-orcid":false,"given":"Paola","family":"Parisi","sequence":"first","affiliation":[{"name":"Department of Plastic and Regenerative Surgery, San Gallicano Dermatological Institute IRCCS, 00144 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3058-767X","authenticated-orcid":false,"given":"Flavio Andrea","family":"Govoni","sequence":"additional","affiliation":[{"name":"Department of Maxillo-Facial Surgery, San Camillo Forlanini Hospital, 00152 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7138-8098","authenticated-orcid":false,"given":"Tiziano","family":"Pallara","sequence":"additional","affiliation":[{"name":"Department of Plastic and Regenerative Surgery, San Gallicano Dermatological Institute IRCCS, 00144 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8054-7190","authenticated-orcid":false,"given":"Antonio","family":"Bonadies","sequence":"additional","affiliation":[{"name":"Department of Plastic and Regenerative Surgery, San Gallicano Dermatological Institute IRCCS, 00144 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5816-5834","authenticated-orcid":false,"given":"Marinella","family":"Tedesco","sequence":"additional","affiliation":[{"name":"Department of Plastic and Regenerative Surgery, San Gallicano Dermatological Institute IRCCS, 00144 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2152-2483","authenticated-orcid":false,"given":"Elena Rita","family":"Govoni","sequence":"additional","affiliation":[{"name":"Campus Bio-Medico, Faculty of Medicine, University of Rome, 00128 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5316-8937","authenticated-orcid":false,"given":"Emilia","family":"Migliano","sequence":"additional","affiliation":[{"name":"Department of Plastic and Regenerative Surgery, San Gallicano Dermatological Institute IRCCS, 00144 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"746","DOI":"10.1016\/S0161-6420(99)90161-6","article-title":"Epidemiologic characteristics and clinical course of patients with malignant eyelid tumors in an incidence cohort in Olmsted County, Minnesota","volume":"106","author":"Cook","year":"1999","journal-title":"Ophthalmology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1097\/ICU.0b013e328356ad55","article-title":"Topical therapies for periorbital cutaneous malignancies: Indications and treatment regimens","volume":"23","author":"Sullivan","year":"2012","journal-title":"Curr. Opin. Ophthalmol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1097\/01.moo.0000233592.76552.d2","article-title":"Upper and lower eyelid reconstruction: The year in review","volume":"14","author":"Rafii","year":"2006","journal-title":"Curr. Opin. Otolaryngol. Head Neck Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"5","DOI":"10.4103\/0970-0358.81437","article-title":"Reconstructions of eyelid defects","volume":"44","author":"Subramanian","year":"2011","journal-title":"Indian J. Plast. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1016\/j.otc.2005.03.006","article-title":"Lower eyelid Reconstruction","volume":"38","author":"Chandler","year":"2005","journal-title":"Otolaryngol. Clin. N. Am."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1097\/00002341-199209000-00005","article-title":"Eyelid reconstruction with hard palate mucosa grafts","volume":"8","author":"Cohen","year":"1992","journal-title":"Ophthalmic. Plast. Reconstr. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1183","DOI":"10.1136\/bjo.85.10.1183","article-title":"Autogenous hard palate mucosa: The ideal lower eyelid spacer?","volume":"85","author":"Wearne","year":"2001","journal-title":"Br. J. Ophthalmol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.1016\/j.ajo.2003.12.034","article-title":"Hard palate mucosal grafts in oculoplastic surgery: Donor site lessons","volume":"137","author":"Pang","year":"2004","journal-title":"Am. J. Ophthalmol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1016\/0002-9394(89)90257-2","article-title":"Posterior lamellar eyelid reconstruction with a hard palate mucosal graft","volume":"107","author":"Bartley","year":"1989","journal-title":"Am. J. Ophthalmol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"854","DOI":"10.1038\/sj.eye.6701667","article-title":"The \u2018RITE\u2019 use of the Fricke flap in periorbital reconstruction","volume":"19","author":"Wilcsek","year":"2004","journal-title":"Eye"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1430","DOI":"10.1016\/j.bjps.2011.06.044","article-title":"Total lower-eyelid reconstruction: Modified Fricke\u2019s cheek flap","volume":"64","year":"2011","journal-title":"J. Plast. Reconstr. Aesthetic. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"95","DOI":"10.4103\/2006-8808.128749","article-title":"Total Reconstruction of Lower Eyelid in a Post-Traumatic Patient Using Modified Fricke\u2032s Cheek Flap","volume":"5","author":"Sengupta","year":"2013","journal-title":"J. Surg. Technol. Case Rep."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1575","DOI":"10.1016\/S0161-6420(01)00701-1","article-title":"Management and prognosis of Merkel cell carcinoma of the eyelid","volume":"108","author":"Peters","year":"2001","journal-title":"Ophthalmology"},{"key":"ref_14","first-page":"802","article-title":"Histologic safety margin in basal cell carcinoma of the eyelid: Correlation with recurrence rate","volume":"11","author":"Frick","year":"2009","journal-title":"Ophthalmology"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1111\/j.1524-4725.2009.01128.x","article-title":"Double mucosal and myocutaneous island flap: A one-stage reconstruction for full-thickness lower eyelid defect","volume":"35","author":"Garces","year":"2009","journal-title":"Dermatol. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1016\/j.jcms.2012.05.011","article-title":"Objective anthropometric analysis of eyelid reconstruction procedures","volume":"41","author":"Raschke","year":"2013","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1159\/000343624","article-title":"Partial and total lower lid reconstruction: Our experience with 41 cases","volume":"228","author":"Fogagnolo","year":"2012","journal-title":"Ophthalmologica"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2459","DOI":"10.1016\/j.joms.2011.10.017","article-title":"Optimal care for eyelid contraction after radiotherapy: Case report and literature review","volume":"70","author":"Tarallo","year":"2012","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1071","DOI":"10.1016\/S0181-5512(04)96267-5","article-title":"Greffe de fibro-muqueuse palatine en chirurgie palp\u00e9brale [Hard palate mucosal graft for posterior lamella repair]","volume":"27","author":"Guyot","year":"2004","journal-title":"J. Fr. Ophtalmol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1097\/00006534-196206000-00008","article-title":"Correction of senile entropion with fascia-lata graft","volume":"29","author":"Elliot","year":"1962","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1097\/00006534-197352040-00003","article-title":"The anophthalmic orbit. Surgical correction of lower eyelid ptosis","volume":"52","author":"Vistnes","year":"1973","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1016\/S0161-6420(82)34771-5","article-title":"Surgical treatment of the denervated or sagging lower lid","volume":"89","author":"Wiggs","year":"1982","journal-title":"Ophthalmology"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1650","DOI":"10.1097\/00006534-199905000-00011","article-title":"Lower eyelid reconstruction with a cheek flap supported by fascia lata","volume":"103","author":"Matsumoto","year":"1999","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1097\/00006534-196208000-00006","article-title":"Eyelid repairs with a chondromucosal graft","volume":"30","author":"Millard","year":"1962","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_25","unstructured":"Mustard\u00e9, J.C. (1980). Repair and Reconstruction in the Orbital Region, Churchill Livingstone. [2nd ed.]."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1088","DOI":"10.1016\/0002-9394(65)93428-8","article-title":"Tarsal grafting to elevate the lower lid margin","volume":"59","author":"Obear","year":"1965","journal-title":"Am. J. Ophthalmol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1097\/00002341-198501000-00007","article-title":"The use of tarsus as a free autogenous graft in eyelid surgery","volume":"1","author":"Stephenson","year":"1985","journal-title":"Ophthalmic. Plast. Reconstr. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/S0161-6420(84)34326-3","article-title":"Use of temporalis fascia in eyelid reconstruction","volume":"91","author":"Holt","year":"1984","journal-title":"Ophthalmology"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1097\/00002341-198501000-00004","article-title":"Autogenous auricular cartilage grafting for lower eyelid retraction","volume":"1","author":"Baylis","year":"1985","journal-title":"Ophthalmic. Plast. Reconstr. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1097\/00006534-198710000-00012","article-title":"Lower eyelid reconstruction with a conchal cartilage graft","volume":"80","author":"Matsuo","year":"1987","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1339","DOI":"10.1001\/archopht.1990.01070110155041","article-title":"Management of lower-lid retraction with hard-palate mucosa grafting","volume":"108","author":"Kersten","year":"1990","journal-title":"Arch. Ophthalmol."},{"key":"ref_32","first-page":"677","article-title":"Closure of eyelid defects by transplantation of lid margin and tarsus","volume":"168","year":"1976","journal-title":"Klin. Monbl. Augenheilkd."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/0007-1226(94)90120-1","article-title":"Island chondro-mucosal flap and skin graft: A new technique in eyelid reconstruction","volume":"47","author":"Scuderi","year":"1994","journal-title":"Br. J. Plast. Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1786","DOI":"10.1097\/SCS.0b013e3181f4048f","article-title":"Reconstruction of the lower eye lid with a rotation-advancement tarsoconjunctival cheek flap","volume":"21","author":"Wessels","year":"2010","journal-title":"J. Craniofacial Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/j.ophtha.2007.03.022","article-title":"Orbicularis muscle advancement flap combined with free posterior and anterior lamellar grafts: A 1-stage sandwich technique for eyelid reconstruction","volume":"115","author":"Paridaens","year":"2008","journal-title":"Ophthalmology"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/7\/2503\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:11:21Z","timestamp":1760029881000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/7\/2503"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,7]]},"references-count":35,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["jcm14072503"],"URL":"https:\/\/doi.org\/10.3390\/jcm14072503","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,7]]}}}