Posterior wedge resection
Richard C. Allen, MD, PhD, FACS
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This is Richard Allen at the University of Iowa. This video demonstrates excision of a nevus at the mucocutaneous junction of the lower lid. Repair will involve a posterior wedge with vertical advancement of the anterior lamella. This is performed in order to avoid a vertical scar in the eyelid and give the scar of a subciliary incision. A 15 blade is used to make an incision just inferior to the lesion. A subsequent incision is then extended on either side of the lesion. The 15 blade is then used to excise a wedge of the mucocutaneous junction with the tarsus. Dissection is then carried out inferiorly between the orbicularis muscle and the orbital septum. This is performed inferiorly to the inferior orbital rim so that the anterior lamella can be advanced. The posterior lamellar defect is then closed with interrupted 5–0 Vicryl sutures which are placed partial thickness through the anterior surface of the tarsus. Two sets of sutures are placed and then tied. The lid margin is then closed just as one would close a wedge resection lid margin. This will be performed with 7–0 Vicryl sutures which are placed in a vertical mattress fashion. One suture will be placed at the Meibomian gland orifices. The other suture will be placed at the lash follicles. This will result in eversion of the lid margin. The subciliary incision is then closed with interrupted 7–0 Vicryl sutures. Again, the advantage of this procedure is to avoid a vertical scar which can be more noticeable than the subciliary scar which is commonly used for lower lid blepharoplasties.