Myocutaneous advancement flap
This is Richard Allen at the University of Iowa. This video demonstrates closure of a medial anterior lamellar defect using a myocutaneous advancement flap. A traction suture is placed with a 4-0 silk suture. A subcilliary incision is then made with the monopolar cautery extending from the lateral portion of the defect to the lateral canthus. Dissection is then carried out between the orbicularis muscle and the orbital septum to the inferior orbital rim. The flap is raised and further dissection is carried out in the same plane laterally. The lower eyelid will be stabilized by performing a lateral tarsal strip in the standard fashion. The strip will be fixated to the lateral orbital rim at the level of Whitnalls tubercle with 4-0 mersilene suture. The flap is then transposed to insure that there is not excessive tension. Deep interrupted buried 5-0 vicryl sutures are then placed to relieve tension at the skin edge. Approximated 3-4 of these sutures are placed. The subcilliary incision is then closed with interrupted 5-0 fast absorbing sutures. The skin at the junction of the flap and medial edge of the defect is then closed with interrupted 6-0 prolene sutures placed in a vertical mattress fashion. The apex of the flap, which is at minimal or no tension, is closed with an interrupted 5-0 fast absorbing suture. The traction suture is then removed.