Repair of lateral canthal defect
This is Richard Allen at the University of Iowa. This video demonstrates repair of a lateral canthal defect. Repair of this defect will take advantage of shortening the posterior lamella in order to gain anterior lamellar redundancy. This is especially useful with anterior lamellar defects. The defect is noted and a lateral canthotomy is performed followed by an inferior cantholysis. A lateral tarsal strip is fashioned by dissecting between the anterior and posterior lamella for approximately 1 centimeter. The mucocutaneous junction of the posterior lamella is excised. The posterior surface of the strip is scraped and the strip is shortened. The strip will then be sutured to the lateral orbital rim at the level of Whitnall's tubercle with a double-armed 4-0 Mersilene suture on an S2 needle. By doing this, the posterior lamella is shortened which then enables the defect in the anterior lamella to be negated. In other words, by shortening the posterior lamella in relation to the anterior lamellar defect, there is no disassociation in length between the anterior and posterior lamella. The strip of lashes are excised. A deep suture is placed with a 4–0 Vicryl suture. This is placed in a buried fashion. As noted now, there is little tension on the anterior lamellar closure. The anterior lamella is then re-associated with the lateral tarsal strip in order to prevent a web. This is performed with a 5-0 fast-absorbing suture. The skin can then be closed with interrupted 5-0 fast absorbing sutures placed in a combination of an interrupted as well as a horizontal mattress fashion. At the conclusion of case, the defect is repaired with minimal tension on the wound.
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