Repair of a lateral canthal defect with an O to Z flap
Richard C. Allen, MD, PhD, FACS
Length: (01:50)
This is Richard Allen at the University of Iowa. This video demonstrates repair of a lateral canthal defect with an O to Z flap. A number of flaps could be fashioned in order to repair this defect. In this case, a subciliary incision is made extending from the medial portion of the defect medially. Wide undermining is then performed between the orbicularis muscle and the orbital septum. An incision is then made to complete the Z extending from the lateral portion of the defect superiorly. Dissection is then carried out in the subcutaneous fat plane. Transposition of the flap shows good coverage of the defect. For these cases, I prefer to tighten the lower eyelid. This could be performed with a lateral canthopexy. In this case, a lateral tarsal strip is performed. A lateral canthotomy and inferior cantholysis are performed followed by fashioning of the lateral tarsal strip. The strip will then be sutured to the lateral orbital rim at the level of Whitnall's tubercle with a 4-0 Mersilene suture. The flaps are then placed into position. A deep 4–0 Vicryl suture is placed through the inferior flap which then engages the periosteum of the lateral orbital rim. This results in elevation of the cheek and will take tension off of the lower eyelid. Additional deep sutures are placed with 5–0 Vicryl sutures followed by superficial 5-0 fast-absorbing sutures to complete the repair.
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