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After Mohs surgery for basal cell carcinoma, a 61-year-old man received a free FDMA flap with favorable viability, integration, and outcomes at six months.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/lower-eyelid-and-cheek-reconstruction-with-the-first-dorsal-metacarpal-artery-free-flap-a-case-report/423028/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/lower-eyelid-and-cheek-reconstruction-with-the-first-dorsal-metacarpal-artery-free-flap-a-case-report/423028.png","ImageObject",300,407,{"name":42,"@type":43},"pixelkiddo","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-31","2026-09-28",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",9,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"Why are full-thickness lower eyelid reconstructions considered challenging?","Question",{"text":63,"@type":64},"They require simultaneous functional protection, dynamic closure, and aesthetic harmony, which is difficult to achieve with many available flap options.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"What flap technique was used in this case report?",{"text":68,"@type":64},"A free first dorsal metacarpal artery (FDMA) flap was harvested from the dorsum of the hand and used to reconstruct a full-thickness lower eyelid defect.",{"name":70,"@type":61,"acceptedAnswer":71},"What clinical outcomes were reported after surgery?",{"text":72,"@type":64},"The flap remained viable throughout hospitalization without ischemic complications, and at six months the patient had complete eyelid closure and high satisfaction based on FACE-Q Eye Module scores.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},423028,1790942319,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,110,115,119,122,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":102,"doc_module":4,"doc_module_name":25,"category_name":103,"show_sort_weight":104,"slug":105},6,"Technology",50,"technology",{"id":107,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":108,"slug":109},7,40,"healthcare",{"id":111,"doc_module":4,"doc_module_name":25,"category_name":112,"show_sort_weight":113,"slug":114},8,"Research & Report",30,"research-report",{"id":55,"doc_module":4,"doc_module_name":25,"category_name":116,"show_sort_weight":117,"slug":118},"Religion & Spirituality",20,"religion-spirituality",{"id":117,"doc_module":4,"doc_module_name":25,"category_name":120,"show_sort_weight":117,"slug":121},"World Cup","world-cup",{"id":123,"doc_module":4,"doc_module_name":25,"category_name":124,"show_sort_weight":123,"slug":125},10,"Lifestyle","lifestyle",{"id":127,"doc_module":4,"doc_module_name":25,"category_name":128,"show_sort_weight":97,"slug":129},19,"General","general",{"code":4,"msg":82,"data":131},{"doc_id":79,"user_id":132,"nickname":42,"user_avatar":133,"doc_module":4,"category_id":107,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":102,"language":139,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":12,"update_tm":143,"read_time":144,"preview_page_count":4},962090883892,"https://ap-avatar.wpscdn.com/avatar/e00115db34f3e0f11b?x-image-process=image/resize,m_fixed,w_180,h_180&k=1790152879550218658","Review began 11/17/2025  \nReview ended 12/01/2025  \nPublished 12/04/2025  \n© Copyright 2025  \nDíaz Hernández et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited.  \nDOI: 10.7759/cureus.98445  \nOpen Access Case Report  \nLower Eyelid and Cheek Reconstruction With the First Dorsal Metacarpal Artery Free Flap: A Case Report  \nSergio Alejandro Díaz Hernández 1, Diana Vianney Díaz Avila 1, Diego López Gutiérrez Rafael Reynoso Campo 1, Alfonso E. Echeverria Desentis 1  \n1. Plastic Surgery, Hospital General de México “Dr. Eduardo Liceaga”, Mexico City, MEX Corresponding author: Alfonso E. Echeverria Desentis, [aecheverriad@gmail.com](aecheverriad@gmail.com)  \n1  \n,  \nAbstract  \nReconstruction of full-thickness lower eyelid defects remains a complex challenge due to the simultaneous requirements of functional protection, dynamic closure, and aesthetic harmony. Various local and free flaps exist, but limitations such as donor-site morbidity, bulkiness, or poor color match persist. To our knowledge, based on a structured literature search of PubMed, Scopus, and Web of Science (database inception to November 2025), there are no previously published reports describing the use of the first dorsal metacarpal artery (FDMA) flap as a free flap for reconstruction of lower eyelid or adjacent malar defects. We report the case of a 61-year-old male with a 4 × 3 cm left lower eyelid lesion diagnosed as basal cell carcinoma, adenoid (adenocystic) variant. After Mohs micrographic surgery, the resulting 3.6 × 3.2 cm full-thickness defect was reconstructed using a free FDMA flap harvested from the dorsum of the hand. Microvascular anastomoses were performed with the superficial temporal vessels, and the donor site was resurfaced with a full-thickness skin graft. The flap remained viable throughout hospitalization with no ischemic complications. On postoperative day seven, flap integration and donor-site healing were satisfactory. At six months, the patient showed complete eyelid closure (lagophthalmos 0 mm), eyelid margin symmetry within 1 mm, and apalpebral aperture of 9 mm. Objective assessment demonstrated favorable Patient and Observer Scar Assessment Scale scores (observer, 11/60; patient, 13/60), and the FACE-Q Eye Module confirmed high satisfaction (appearance, 88/100; comfort, 92/100) . The flap showed stable contour and excellent integration with adjacent tissues. This case demonstrates the feasibility of using the free FDMA flap for complex lower eyelid and malar reconstruction, offering thin, pliable tissue with favorable aesthetic and functional outcomes. As the first reported application of this flap in this anatomical region, it broadens thereconstructive options for periocular oncologic defects and supports further investigation through larger and longer-term studies.  \nCategories: Plastic Surgery, Oncology, Dermatology  \nKeywords: basal cell carcinoma (bcc), fdma flap, free microvascular flap, lower eyelid reconstruction, microsurgery  \nIntroduction  \nReconstruction of soft tissue defects in the facial region poses a significant challenge in reconstructive surgery, given the intricate anatomy, essential function, and high aesthetic demands inherent to this area. The etiology of such defects is varied ; however, defects resulting from the resection of a basal cell carcinoma (BCC), the most common malignant skin neoplasm [1], need to be studied for the achievement of successful facial reconstruction, as well as to improve the quality of life of patients significantly by restoring their facial appearance, self-esteem, and capacity for social integration [2] .  \nGiven the limitations of conventional eyelid and midface reconstruction techniques in large or full-thickness defects, exploring alternative microsurgical options capable of providi","cbCaitRl2VVlyDhm","https://ap.wps.com/l/cbCaitRl2VVlyDhm","pdf",1802798,"English","# Abstract\n# Introduction\n# Case Presentation\n## How to cite this article","[{\"question\":\"Why are full-thickness lower eyelid reconstructions considered challenging?\",\"answer\":\"They require simultaneous functional protection, dynamic closure, and aesthetic harmony, which is difficult to achieve with many available flap options.\"},{\"question\":\"What flap technique was used in this case report?\",\"answer\":\"A free first dorsal metacarpal artery (FDMA) flap was harvested from the dorsum of the hand and used to reconstruct a full-thickness lower eyelid defect.\"},{\"question\":\"What clinical outcomes were reported after surgery?\",\"answer\":\"The flap remained viable throughout hospitalization without ischemic complications, and at six months the patient had complete eyelid closure and high satisfaction based on FACE-Q Eye Module scores.\"}]","Lower Eyelid and Cheek Reconstruction With the First Dorsal Metacarpal Artery Free Flap - A Case Report | PDF",1790629800,15]