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’ 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 × 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.

The management of skin cancer presents challenges in reconstructive surgery to achieve the best patient outcome and rapid wound healing. The most used antiseptic in pre and post operative care is Povidone Iodine solution. However, valid antiseptic alternatives should be considered. The primary endpoint of our study was to achieve the best healing in patients receiving fluorescein solution versus two comparator arms (Eosin and Povidone-Iodine).182 patients were enrolled and divided into three randomized groups according to the type of antiseptic solution received: Fluorescein (n = 63), Eosin (n= 60), and Povidone-Iodine (n = 59). To assess the endpoint of our study the ASEPSIS score was used to objectively evaluate graft healing. Results of the ASEPSIS score for each group were analyzed. The comparison demonstrated that there was no statistically significant difference among the three groups regarding the endpoint of our study, thus between fluorescein and povidone-iodine (p = 0.89), eosin and fluorescein (p = 0.54), and eosin and povidone-iodine (p = 0.81). Patients responded positively to the use of the Fluorescein antiseptic solution, although no more than the others. This study suggests that this type of antiseptic can be successfully used in skin graft management.