Modified Fricke's Cheek Flap for Periorbital Reconstruction: A Regional Alternative to Forehead-Based Flaps

Periorbital reconstruction remains challenging due to the region's complex anatomy and essential roles in eyelid function, globe protection, and facial aesthetics. Traditional reconstructive options, such as forehead-based Fricke's flaps, may result in eyebrow distortion and poor color match. The modified Fricke's cheek flap offers a regional alternative with improved mobility, vascularity, and aesthetic integration. This study evaluates flap survival, functional eyelid outcomes, aesthetic results, and complications of this technique in traumatic periorbital defects.

A retrospective observational study was conducted at Shri B.M. Patil Medical College, Hospital and Research Centre, Vijayapura, Karnataka, India, from January 2024 to January 2025. Twenty male patients with traumatic periorbital soft-tissue loss who underwent reconstruction using the modified Fricke's cheek flap performed by a single surgeon were included in the study. Data collected included demographics, defect characteristics, presence of fractures, flap viability, functional outcomes, cosmetic results, and postoperative complications.

Road traffic accidents accounted for 18 (90%) of injuries. Superficial tissue loss occurred in all patients, while deep tissue loss was present in four (20%) patients. Associated fractures were identified in two (10%) patients. Complete flap survival was achieved in 18 (90%), with two (10%) patients developing partial distal flap necrosis, both managed conservatively. No infection, hematoma, ectropion, or wound dehiscence occurred. All patients maintained intact eyelid closure and stable contour. Donor-site morbidity was minimal, and cosmetic outcomes were clinically assessed as satisfactory in all patients, with scars concealed along natural facial creases.

The modified Fricke's cheek flap appears to be a reliable and versatile option for periorbital reconstruction, demonstrating high flap survival and preserved eyelid function in this cohort. While it provides a favorable color and texture match, claims of superiority over forehead-based flaps require further comparative validation. Further comparative studies are warranted to better define its role among regional reconstructive options.