Repair of full-thickness upper eyelid defect
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This is Richard Allen at the University of Iowa.
This video demonstrates repair of an upper eyelid full thickness defect with a combination of direct closure and a myocutaneous flap.
Inspection of the area shows the nature of the defect. Transposition of the eyelid into position shows a bit of redundancy of the anterior lamella compared to the posterior lamella. Therefore, an incision will be made along the eyelid crease to the lateral aspect of the defect. Dissection will then be carried out between the orbicularis muscle and the orbital septum superiorly. This will result in undermining and mobilization of the flap. This will allow redistribution of the anterior lamella superiorly along the eyelid crease. This is performed along the full extent of the defect in between the orbicularis muscle and the orbital septum. A small pedicle of tissue is excised to smooth out the line of the flap.
Attention is then directed to the eyelid margin which can be repaired primarily. Placement of the anterior lamella superiorly shows that it can be redistributed well along the repair. The eyelid margin will be closed by placing 5-0 Vicryl sutures through the anterior surface of the tarsus. Two sutures will be placed and tied. The lid margin will then be repaired with a 7-0 Vicryl suture which will be placed at the level of the Meibomian gland orifices. This is a vertical mattress suture which will evert the eyelid margin to prevent a post-operative notch. An additional vertical mattress suture will then be placed at the level of the lash follicles. The anterior lamella is then redistributed along the eyelid crease. This will be closed with the same 7-0 Vicryl suture. A 6-0 monofilament suture could be used if preferred. At the conclusion of the case, the defect is repair without creating an eyelid malposition. Antibiotic ointment is place three times per day and the patient will return in one week for suture removal.