Upper Eyelid Advancement Flap 2
This is Richard Allen at the University of Iowa. This video demonstrates the use of an upper lid advancement flap to cover a defect that is superior in position. Similar to another video in which a defect is inferior in position, an advancement flap is designed with medial and lateral triangles which mimic a blepharoplasty incision. The dissection plane used here is between the orbicularis muscle and orbital septum. This could be performed with either Westcott scissors as seen here or monopolar cautery. The defect is widely undermined and the advancement flap is placed into position. Gain, this is performed in the plane between the orbicularis muscle and orbital septum. I don't think that any deep sutures are needed in this reconstruction, therefore superficial sutures are placed with 6-0 prolene suture. Other options for this defect would include a full-thickness skin graft or other flap designs. At the conclusion of the case there should minimal tension on the lid margin and no lagophthalmos.