Abstract
The Fricke flap was first described in 1829 as a temporally based monopedicle flap originating from above the brow. This flap is an option for reconstructing significant laterally positioned upper and lower eyelid anterior lamellar defects. The original description of the flap suggested an indication in which the flap could be tunneled under healthy lateral eyelid tissue to reconstruct a more medial defect. Modifications have been described in which the flap bridges over healthy tissue to reach medial defects. Both approaches are not considered the procedure of choice for more medial defects. When a posterior lamella defect is present, additional support through hard palate graft, harvested cartilage, etc. may be used.
The tissue utilized for the temporal forehead flap is located superior to the eyebrow with its medial limit extending as far as the supraorbital notch and the pedicle based temporal to the orbital rim. While this tissue is a good color match with the eyelid tissue it is significantly thicker and often needs to be thinned. Care must be taken to avoid damaging temporal branches of the facial nerve during this dissection, particularly along the medial brow where these branches are fairly superficial.