Mucous membrane graft for repair of upper lid cicatricial entropion
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This is Richard Allen at the University of Iowa. This video demonstrates placement of a mucous membrane graft to the upper eyelid in an anophthalmic patient with upper cicatricial entropion. A 4-0 silk suture is placed though the upper eyelid margin at the level of the meibomian gland orifices. The eyelid is everted and the area of the scar is identified. A thermal cautery is used in this case to make an incision through the scar. The thermal cautery is then used to further release the scar and dissection is carried out between the conjunctiva and the underlying Muellers muscle. This is performed in order to fully release the scar. The size of the graft needed is then estimated and a template can be made from the ruler. A buccal mucous membrane graft is then harvested. This is demonstrated in a separate video. A double armed 5-0 vicryl suture is then used to engage the buccal mucosa. Each arm of the suture then engages the superior edge of the conjunctiva and then directed full-thickness through the eyelid at the desired height of the upper fornix. Each arm is placed in the exact same manner. Again, this is a full thickness suture. An additional suture is placed in the same manner centrally, engaging the buccal mucosa followed by the superior edge of the conjunctiva, and then full thickness through the eyelid at the desired height of the fornix. A third and final lateral suture is then placed in the exact same manner. The sutures are then tightened in order to position the mucous membrane graft appropriately. The sutures are then tied over cotton bolsters. The inferior edge of the mucous membrane graft is then sutured to the inferior border of the tarsus/conjunctiva. This is performed in this case with interrupted 7-0 vicryl sutures. If the patient were not anophthalmic, these sutures would need to be placed in a buried fashion. At the conclusion of the case, a conformer is placed and the reverse Frost sutures are taped to the cheek, and the patient is patched for one week.
