Two separate full thickness skin grafts
This is Richard Allen at the University of Iowa. This video demonstrates the use of two separate full-thickness skin grafts to cover a lower eyelid defect after Mohs excision of a basal cell carcinoma. A lateral tarsal strip is performed in the standard fashion to stabilize the eyelid. The upper eyelid skin is harvested using the monopolar cautery. A blade and scissors could be used as well. It is important to not to excise excessive skin from the upper lid. The incision is then closed with a running 6-0 prolene suture. The graft is then placed into position and, as noted, it will not be enough to cover the defect. Therefore, an additional graft was taken from the contralateral upper eyelid and placed into postion. After trimming the grafts the appropriate amount, the grafts are sutured into position with 5-0 fast absorbing suture. Other options for covering this defect would include skin from the supraclavicular or retroauricular area. The sutures are placed at cardinal positions in an interrupted fashion, followed by a running suture. The two grafts are then sutured together with the same 5-0 fast absorbing suture. As noted, this results in adequate coverage of the defect. The area is then cleaned followed by the application of antibiotic ointment and a bolster. The eye is then patch for one week with the eyelid on stretch with a Frost suture. The patient returns in one week for removal of the patch, bolster, and sutures.