Periosteal strip and mid-face lift for repair of lateral full-thickness defect
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This is Richard Allen at the University of Iowa. This video demonstrates repair of a lateral defect of the anterior and posterior lamella of the lower lid with a periosteal strip and mid-face lift. A relatively generous anterior lamellar flap is used in this case due to a shortening of the skin from actinic damage. A 4-0 Silk suture is placed though the lower eyelid margin to provide traction during the case. A subciliary incision is then made with the needle tip cautery extending from the punctum medially to the defect laterally. Dissection is then carried out between the orbicularis muscle and the orbital septum to the inferior orbital rim. Dissection is then carried out inferior to the inferior orbital rim in a preperiosteal plane with the freer periosteal elevator.
A periosteal strip will be raised laterally by making an incision through the periosteum with the 15 blade. The strip is then raised with a freer periosteal elevator and reflected medially. The lateral portion of the posterior lamella was excised by the Mohs surgeon. A 5-0 Vicryl suture on a taper needle is then place through the periosteal strip followed by the lateral tarsus. This is a mattress suture which, when tied, will result in the periosteal strip being anterior to the lateral portion of the tarsus. This results in adequate tension of the lower lid and repair of the posterior lamella.
A preperiosteal mid-face lift is then performed by engaging the soft-tissue of the cheek with a 4-0 Vicryl suture. This suture is then placed through the periosteum of the inferior orbital rim. Tying the suture results in elevation of the mid-face. An additional suture is placed, and then a suture is placed laterally which engages the periosteum of the lateral orbital rim at the level of the periosteal strip. This results in adequate superior mobilization of the mid-face. An additional deep suture is placed through the orbicularis muscle laterally. The lateral canthus is then repaired with interrupted with interrupted 5-0 fast absorbing sutures. The subciliary incision is closed with a running 5-0 fast absorbing suture. At the conclusion of the case, the tension along the lower lid appears to be adequate. Antibiotic ointment is used three times per day. The patient will return in one week for reevaluation.