Glabellar flap for medial canthal defect
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This is Richard Allen at the University of Iowa. This video demonstrates a glabellar flap for repair of a medial canthal defect. In general I think medial canthal defects which are superior to the medial canthal tendon are best repaired with this procedure. The flap has been designed and a 15 blade is used to make an incision along the markings. Dissection is then carried out below the subcutaneous fat to elevate the flap. Wide undermining is then performed in the donor area. The flap is transposed which appears to cover the area well. In general, I think it's wise to oversize the flap and remove any redundant tissue later rather than have a flap that is too small. The donor site can then be closed with deep interrupted 4–0 Vicryl sutures. By closing the donor site, the flap is usually transposed into position. The posterior surface of the flap is engaged with a 5–0 Vicryl suture which then engages the periosteum of the defect. This will seat the flap. The flap appears to cover the defect well. The donor site is then closed with superficial 5–0 Prolene sutures placed in a vertical mattress fashion to gently evert the skin edges. The flap is then sutured into position with interrupted 6–0 Prolene sutures placed in an interrupted fashion. A redundant portion the flap is excised. Again, I think it's wise to oversized these flaps and excise some later rather than to be short. The flap is also thinned at the area where it will be sutured to the thin eyelid skin. Additional 6–0 Prolene sutures are placed. Inferiorly, there appears to be some redundancy to the area. A Burow's triangle will be excised. In general, it is wise to direct these incisions away from the base of the flap so that the flap is not compromised. Additional 6–0 Prolene sutures are placed. At the conclusion of the case, the flap covers the area well. The patient will follow-up in approximately 1 week for reevaluation and suture removal.