Repair of 50% of the lower eyelid
This is Richard Allen at the University of Iowa. This video demonstrates repair of a full-thickness lower eyelid defect which involves approximately 50% of the lid.
Repair will be performed by separating the anterior and posterior lamella and repairing each lamella separately.
4-0 silk suture is placed through the eyelid margin to provide traction during the case.
The monopolar cautery is then used to make a subciliary incision extending from each edge of the defect.
Dissection is carried out between the orbicularis muscle and orbital septum to the inferior orbital rim.
This essentially separates the anterior lamella from the posterior lamella.
Dissection is carried out to the extent that mobilization of the anterior lamella will cover the defect.
The traction sutures are removed and the edges of the posterior lamella are freshened and squared off with Westcott scissors.
The posterior lamellar defect is then repaired with interrupted 5-0 Vicryl sutures that are placed partial thickness through the anterior surface of the tarsus.
Two such sutures are placed and then tied. This places the lid margin in appropriate position.
The lid margin is then repaired as one would repair a wedge resection by placing 7-0 Vicryl sutures in a vertical mattress fashion, one at the level of the meibomian gland orifices and one at the level of the lash follicles.
These sutures result in eversion of the wound at the lid margin to prevent subsequent notching.
The anterior lamella is then redraped over the posterior lamella and sutured into position with the skin suture of your choice. In this case, the same 7-0 vicryl suture is used.
At the conclusion of the case, the eyelid is in good position and the patient returns in one week for reevaluation.