Repair of inferior lateral anterior lamellar defect
This is Richard Allen at the University of Iowa. This video demonstrates repair of a lateral inferior defect. The defect is inspected. It is an anterior lamellar defect. A semicircular flap is planned. A lateral canthotomy and inferior cantholysis will be performed. A lateral tarsal strip will be performed in order to stabilize the eyelid. The strip is developed. Wide undermining is then performed around the defect. Transposition of the flap covers the defect well. The strip is shortened and the mucocutaneous junction is excised. The posterior surface of the strip is scraped with a 15 blade. The strip is then engaged with a double-armed 4-0 Mersilene suture. The sutures then engage the lateral orbital rim at the level of Whitnall's tubercle. Tying the suture results in tightening and stabilization of the lower lid. The flap is transposed over the defect and appears to cover it well. The flap will be sutured into position with deep interrupted 5–0 Vicryl sutures. 2 sutures are placed in order to oppose the flap. Superficial sutures are then placed with 5-0 fast-absorbing suture. The anterior lamella is reassociated with the posterior lamella of the lateral tarsal strip. The lateral canthotomy incision is then closed with the same suture. Attention is then placed on superficial closure. This is performed with interrupted 5-0 fast absorbing sutures placed in a horizontal mattress fashion. At the conclusion of the case, the flap covers the defect well with minimal tension. The patient will use Erythromycin ophthalmic ointment 3 times a day. The patient will follow-up in approximately 1 week for reevaluation.
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