Posterior wedge resection #2
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This is Richard Allen at the University of Iowa. This video demonstrates a posterior wedge resection in a patient with a shallow defect in the central portion of the lower eyelid. Traditionally, a wedge resection with a vertical incision in the anterior lamella could be performed. In this case, a subciliary incision is extended from the defect both medially and laterally. Dissection is then carried out between the orbicularis muscle and the orbital septum to the inferior orbital rim. This will allow mobilization of the anterior lamella. The wedge resection is then performed on the posterior lamella with a 15 blade. Westcott scissors are used to complete the wedge resection. The posterior lamella can then be repaired separately from the anterior lamella. This is performed with a 5–0 Vicryl suture which is placed partial thickness through the anterior surface of the tarsus. Tying the suture results in reapposition of the tarsus. Two sutures will be placed. Attention is then directed to the lid margin. This will be repaired with 7–0 Vicryl sutures placed in a vertical mattress fashion. One suture is placed at the level of the Meibomian gland orifices. An additional suture will then be placed at the lash follicles. This will result in a gentle eversion of the lid margin. This will help prevent a subsequent notch. The subciliary incision can then be closed with the same 7–0 Vicryl suture. This is placed in an interrupted fashion. Again, the advantage of this procedure is to prevent a vertical scar in the anterior lamella. The subciliary scar heals very well. At the conclusion of the case, the patient will use erythromycin ophthalmic ointment 3 times a day. The patient will follow-up in approximately 1 week for reevaluation.