Lateral Semicircular Flap
This is Richard Allen at the University of Iowa. This video demonstrates the use of a small semicircular rotational flap in order to cover a lateral anterior lamella defect. Prior to covering the defect the eyelid will be shortened horizontally as in the case of many lower lid reconstructions. A lateral tarsal strip is performed in the standard manner. Canthotomy, cantholysis, dissection between the anterior and posterior lamella, excision of the mucocutaneous junction, scraping the tarsal conjunctiva, shortening the strip, and suturing the strip to the lateral orbital rim at the level of Whitnalls tubercle with a double armed 4-0 Mersiline suture on an S-2 needle. The suture is tied and the eyelid is in good position. The rotational flap is designed so that an incision will be made in a superior and lateral position. This is made with the 15 blade and then dissection is then carried out within the subcutaneous fat plane. This is performed in this instance with a monopoloar cautery; scissors could be used as well. Wide undermining is performed at the medial edge of the defect. The rotational flap is engaged deep with a 4-0 Vicryl suture and sutured to the lateral orbital rim to provide support of the flap. The flap is then sutured into position with deep interrupted 5-0 vicryl sutures. The superficial skin is then closed with interrupted 5-0 fast absorbing sutures.