Indications. The operation is usually performed for cicatrices about the upper lid, the flap being turned down from the side of the forehead. A flap may be turned in from the inner side in addition if necessary. The operation may also be applied to ectropion of the lower lid.
Fig. 158. Fricke’s Operation. To replace the loss of portions of the skin of the upper lid.
Operation. When planning the flaps the following points must be taken into account:—
(i) The flap must be cut so that its base contains the main blood-supply of the part made use of.
(ii) It should be at least one-third larger than the area to be covered. This is estimated by cutting a piece of protective the size of the area to be covered and laying it on the skin before the flap is cut.
(iii) The base of the flap should consist of a considerable amount of subcutaneous tissue as well as skin, but the apex may be little more than the skin itself.
(iv) The direction of the subsequent contraction should be taken into account so as to assist the final result.
First step. The lid is first freed by dividing all the cicatricial bands, or, if only a small cicatrix be present, by excising that. The lid is then pulled down into position and put fully on the stretch. This is best performed by stitching the margin of the lid to the cheek.