Repair of a lateral canthal defect with a full-thickness skin graft
This is Richard Allen at University of Iowa. This video demonstrates repair of a lateral canthal defect with placement of a skin graft. The patient has significant cicatricial changes which will not allow closure with regional flaps. The lower lid will be tightened with a lateral tarsal strip. A lateral canthotomy and inferior cantholysis are performed followed by fashioning of the lateral tarsal strip. The mucocutaneous junction is excised followed by scraping the posterior surface of the strip. The strip is then shortened appropriately. The strip is then sutured to the lateral orbital rim at the level Whitnall's tubercle with a double-armed 4-0 Mersilene suture. A template is then made of the defect. A full-thickness skin graft is then harvested from the retroauricular area. The graft is then sutured into position with interrupted 5-0 fast-absorbing sutures. Again, flaps could be designed, but due to the actinic damage of the patient's face, adequate mobilization would not be able to be performed. 6-0 silk sutures are then placed around the graft. Antibiotic ointment is placed over the graft followed by a foam bolster which is sutured into position with the 6-0 silk sutures. The patient will follow-up in one week for bolster removal.
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