Full thickness skin graft for cicatricial ectropion
This is Richard Allen at the University of Iowa. This video demonstrates repair of cicatricial lower lid ectropion with a full thickness skin graft. A subciliary incision has been made to release the area of anterior lamellar deficiency. Additional dissection is performed to release the lower lid completely so that it can be freely mobilized superiorly. As with almost every lower lid malposition, horizontal tightening will be performed. In this case, a lateral tarsal strip is fashioned, dissection is carried out between the anterior and posterior lamella, the strip is then sutured to the lateral orbital rim at the level of Whitnalls tubercle with a 4-0 mersilene suture. The defect is then inspected and a template of the defect is made with Telfa dressing. The template is placed to insure appropriate sizing. The template will then be transferred to the area of the donor site. In this case, a retroauricular graft will be taken. There is a separate video demonstrating this type of harvest. The graft is then thinned of all subcutaneous tissue so that only dermis and epidermis remain. The graft is then placed into position over the defect and sutured into position with interrupted and running 5-0 fast absorbing suture. I prefer this suture as it degrades relatively quickly and does not need to be removed. 6-0 silk sutures are then placed at cardinal positions around the graft in order to secure a bolster. The sutures are cut long. Antibiotic ointment is then placed over the graft followed by the Telfa template followed by the bolster. The bolster in this case is taken from a scrub sponge. The Frost suture is taped to the forehead and a double eye pad is placed over the repair for one week. The patient returns in one week for patch, as well as suture, removal.