Pedicle flap from brow to upper eyelid
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This is Richard Allen at the University of Iowa. This video demonstrates the transposition of a pedicle flap from above the brow to the upper eyelid. The patient has a history of a congenital 7th nerve palsy, s/p multiple surgeries and a recent gold weight extrusion. This has resulted in a shortened anterior lamella along the upper lid. A gold weight is going to be reinserted, therefore a skin graft cannot be placed due to the compromised bed. A 15 blade is used to make an incision along the upper eyelid crease. The monopolar cautery is used to dissect to the underlying orbital septum. The levator aponeurosis is identified and the thermal cautery is used to dissect the levator aponeurosis from the anterior surface of the tarsus. The pretarsal orbicularis is dissected from the anterior surface of the tarsus. The gold weight is sutured to the anterior surface of the tarsus with 6-0 prolene suture. The orbicularis of the inferior portion of the incision is then sutured to the cut end of the levator aponeurosis. This provides creation of an eyelid crease and also eversion of the eyelashes. This is sutured with 7-0 vicryl suture.
The 15 blade is then used to make an incision along the markings above the brow to develop the pedicle flap. The flap will be raised with the monopolar cautery. Creation of the defect above the brow followed by closure may result in elevation of the brow and obviating the lengthening of the anterior lamella inferior to the brow. To lessen the brow elevation, wide dissection will be performed with the monpolar cautery superiorly to mobilize this area. The flap is laid into position. Portions of the subcutaneous fat are excised to thin the flap to match the thinner eyelid skin. The flap is then sutured into position with a combination interrupted and running 6-0 prolene suture. Placing the flap thus results in lengthening the anterior lamella between the brow and the eyelashes. The brow incision is then closed with deep interrupted 4-0 vicryl suture followed by superficial running 5-0 Prolene suture. At the conclusion of the case erythromycin ophthalmic ointment is applied three times a day and the patient returns in approximately one week for suture removal.