Second Stage Hughes Flap
This is Richard Allen at the University of Iowa. This video demonstrates a second stage Hughes flap.
The patient is the same one from the Hughes flap video and is now seen 3 weeks after the initial surgery.
Local anesthetic is placed along the upper and lower eyelid.
There is a button hole in the conjunctiva which is of no consequence to the repair.
A groove director is used and placed under the flap.
This helps protect the cornea from the blade or scissors that will be used to transect the flap.
In this case, scissors are used to release the flap.
In releasing the flap, some residual portions of the conjunctiva are left at the lid margin which can be excised with the Westcott scissors.
This is performed in order to prevent subsequent erythema along the lid margin which can be a problem after a Hughes flap. As you can see the eyelid is in good position.
Gentle cautery can then be placed at any active areas of bleeding.
At the conclusion of the case, antibiotic ointment is placed and the patient returns in approximately one month for reevaluation.