Repair of lowerlid/cheek defect with a rhomboid flap
This is Richard Allen at the University of Iowa. This video demonstrates repair of a left lower lid/cheek defect with a rhomboid flap. The rhomboid flap is designed so that the eventual donor site will be closed vertically. A 15 blade is used to make an incision along the markings. Wescott scissors are then used to elevate the flap. Wide undermining is performed around the area of the donor site as well as the defect. The flap is transposed into position. Additional wide undermining is performed in order to mobilize the tissue. The flap is again transposed which results in adequate repair. Deep 5-0 Vicryl suture is placed to close the donor site. Again, this results in a relatively vertical scar which minimizes cicatricial force on the lower lid. The flap is trimmed in order to fit the defect. The flap is then sutured into position with superficial 6–0 Prolene sutures placed in a vertical mattress fashion as well as a simple interrupted fashion. A small Burow's triangle is excised superiorly. Additional sutures are placed. At the conclusion of the case, the defect is closed and there is minimal tension on the lower lid. The patient will return in approximately one week for suture removal.
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