Mucous membrane graft with fornix sutures for shallow fornix in an anophthalmic socket
This is Richard Allen at the University of Iowa. This video demonstrates placement of a mucous membrane graft with fornix deepening sutures in an anophthalmic patient who has a shallow inferior fornix. The patient is unable to hold his prosthesis. 4-0 silk sutures are placed through the lower lid at the level of the tarsus in order to provide traction. The needle tip cautery is then used to make a transconjunctival incision inferior to the inferior border of the tarsus. This dissection then proceeds between the orbicularis muscle and the orbital septum to the inferior orbital rim. The size of the graft needed is then measured. The graft will be harvested from the buccal mucosa. Markings are made to size the graft. Stensen's duct has been previously identified. The needle tip cautery is then used to harvest the graft. This can be performed with scissors if preferred. The graft is harvested and then the defect is closed with a running, locking 5-0 chromic suture.
Attention is then redirected to the graft which is thinned so that only the epithelium and basement membrane remain. The graft is then engaged with 5–0 Vicryl sutures which are placed through the inferior edge of the graft. These are the fornix sutures. 3 double-armed sutures are placed. The sutures are then placed full-thickness through the eyelid at the proposed level of the fornix. Each suture is placed in the same exact manner so that the fornix is created. The sutures will be left untied until the end of the case. 7–0 Vicryl sutures then used to suture the inferior edge of the graft to the cut edge of the conjunctiva. Tightening the sutures pulls the graft into the fornix. The superior edge of the graft is then sutured to the inferior border the tarsus with the same 7–0 Vicryl suture. The patient's artificial eye is then placed. One could place a conformer if preferred. The fornix sutures are then closed over cotton bolsters. The patient will return in approximately 1 week for suture removal. A temporary tarsorrhaphy is placed in this case. This is performed with a 5–0 Vicryl suture. This will be removed at 1 week.
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