Multiple flaps for repair of upper eyelid anterior lamellar defect
This is Richard Allen at the University of Iowa. This video demonstrates the use of multiple flaps to repair a medium sized upper eyelid anterior lamellar defect. The defect is inspected and flaps have been designed medially. This is essentially a bi-lobe flap. The 15 blade is used to make an incision along the previously noted markings. The needle tip cautery is then used to elevate the first lobe of the flap. This is placed in position and noted to cover a minimal portion of the defect. The second lobe of the flap, which is essentially a glabellar flap, is then elevated and placed into position. The donor site is then closed in order to help transpose the flap. The flap is then engaged with a deep 5–0 Vicryl suture which places it into position. Inspection of the remaining defect shows that it will not be able to be closed completely with the designed flaps. An additional flap is designed laterally. An incision is made along the lid crease and the flap is then elevated with the needle tip cautery. This is essentially an advancement flap. Additional dissection is performed in order to advance the flap completely. This is then placed into position and appears to cover the defect without significant tension. Superficial sutures are then placed with 6–0 Prolene suture. This is placed in an interrupted fashion as well as a horizontal mattress fashion. A Burow's triangle is excised laterally. At the conclusion of case, the defect appears to be repaired well. The flap shows minimal tension. The patient will use erythromycin ophthalmic ointment 3 times a day and follow-up for reevaluation and suture removal in one week.
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