Reconstruction of Combined Full-Thickness Defect of the Lateral Canthus and Lateral Upper and Lower Third Eyelids With an Extended Modification of the Fricke Flap, Periosteal Flap, and Conjunctival Flap
Bibliographic record
Abstract
Introduction: The Fricke flap was originally described in 1829 as a laterally based flap from the temporal region that could be used to reconstruct potentially total lower eyelid defects. There have been a few minor modifications of this flap to allow for adjustments of the donor site scar, but none that address the sequelae of brow elevation and allow for reconstruction of a composite defect of the lateral canthus, lateral upper, and lower eyelids. We report our modification of the Fricke flap that allows for total reconstruction of these structures. Clinical Report: A 61-year-old male presented with composite defect of the lateral eyelids and canthus following resection of a basal cell carcinoma by Mohs technique. A Fricke flap was designed and modified to included elements of the above brow and below brow skin as an additional pennant flap. A “Y” shaped periosteal flap and inferior fornix conjunctival flap were also used to reconstruct the posterior lamella. Our surgical technique and follow-up are demonstrated. Discussion: Lateral eyelid and canthal reconstruction can be difficult to reconstruct with a single rotational flap from local sources. We describe our technique of modifying the Fricke flap to include an additional pennant of below brow skin that can be used to reconstruct the lateral eyelids and canthus allowing for a crisp lateral eyelid crease and acceptable donor site and aesthetic appearance. Conclusions: This is the first description of a modification of the Fricke flap that allows for total lateral eyelid and canthus reconstruction.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".