Full-thickness skin graft to lower eyelid for thermal burn
Richard C. Allen, MD, PhD, FACS
Additional Notes: Length 04:02
Posted Feb 10, 2017
This is Richard Allen at the University of Iowa. This video demonstrates a full-thickness skin graft in a patient who has a history of thermal burns. The lower eyelid is inspected. A 4-0 silk suture is then placed through the lower eyelid at the level of the tarsus to provide traction during the case. A 15 blade is then used to make a subciliary incision extending from the medial canthus medially to the lateral canthus laterally. Westcott scissors are then use to dissect through the underlying dermis. Dissection should be performed between the dermis and orbicularis muscle to release the eyelid. This is performed in order to leave a bed of orbicularis muscle for the skin graft. Inspection shows that medially, the lid continues to be somewhat tethered. A 15 blade is used to extend the incision medially. Additional dissection is carried out to completely release the lower lid of any adhesions. After all scar is released and the lid appears to be freely mobile, a lateral tarsal strip will be performed in order to tighten the lid. A lateral canthotomy and inferior cantholysis are performed. Dissection is carried out between the anterior and posterior lamella for approximate 5 millimeters. The mucocutaneous junction of the posterior lamella is excised. The posterior surface of the posterior lamella is scraped with a 15 blade. The strip is shortened by about 2 to 3 millimeters. The strip is then sutured to the lateral orbital rim at the level of Whitnall's tubercle with a double-armed 4-0 Mersilene suture. A template is then made of the resulting defect. In this case, the graft will be taken from the retroauricular area. The graft has been harvested and is placed into position. The graft is then sutured into position with interrupted and running 5-0 fast-absorbing suture. A bolster will be placed with 6-0 silk sutures. These are placed at the edges of the graft. Antibiotic ointment is placed over the Telfa followed by a foam bolster from a hand sponge. It is then fixated into position with the previously placed 6-0 silk sutures. At the conclusion of case, the Frost suture will be taped to the patient's for head. A double eye pad will be placed and the patient will return in approximately 1 week for removal of the patch and the Frost suture.
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