Free Tarsal Graft Harvest
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This is Richard Allen at the University of Iowa. This video demonstrates the harvesting of a free tarsal graft from the upper eyelid. A 4-0 silk suture has been placed through the lid margin and the eyelid is everted over a shoehorn speculum. A marking pen is then used to mark the desired width of the graft. A 4 mm bridge of tarsus is left at the eyelid margin to prevent subsequent kinking. A 15 blade is then used to make an incision through the tarsus. The Westcott scissors are then used to complete the full-thickness incision through the tarsus to expose the underlying pretarsal orbicularis muscle. The Wescott scissors are used to make the incision along the marking, again respecting the plain between the anterior surface of the tarsus and the pretarsal orbicularis muscle. The incision is then made to the superior border of the tarsus where Muller muscle inserts. Again, dissection is carried out long the anterior surface of the tarsus. The scissors are then used to excise the tarsus right at the superior border of the tarsus. The graft is then placed in saline soaked gauze. Light cautery is then applied for hemostasis. Antibiotic ointment is then placed in the eye three times per day for a week.