Full Thickness Wedge Resection Repair
This is Richard Allen at the University of Iowa.
This video demonstrates a lower lid wedge resection with repair of the lower lid.
The patient previously had a Mohs excision of a basal cell carcinoma. The edges of the defect are freshened and squared off with a 15 blade.
The tissue is then excised with the Westcott scissors.
This results in a defect that is full thickness and involves approximately one third of the eyelid.
A 5-0 Vicryl suture is then used to reapproximate the tarsus. Two sutures are placed partial thickness through the anterior surface of the tarsus and then tied. This results in good approximation of the eyelid margin.
7-0 Vicyl suture is then used to reapproximate the eyelid margin. One suture is placed at the level of the meibomian gland orifices in a vertical matress fashion to evert the lid margin and prevent subsequent notching.
A second suture is placed at the level of the lash follicles in the same manner. This then completes closure of the lid margin at both the anterior and posterior lamella.
The skin is then closed with the same 7-0 vicryl suture, or you can use your desired skin suture.
At the conclusion of the case, the lid margin is everted and the defect is well apposed with minimal vertical tension.