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This is Richard Allen at the University of Iowa. This video demonstrates the use of a Tenzel flap to repair a defect of the lower eyelid involving approximately 50% of the length of the lid. Primary closure is not possible, therefore, an interior, inferior cantholysis is performed with the needle tip cautery. The Tenzel flap is then raised by making an incision extending from the lateral canthus superior and lateral. Dissection is then carried out under the orbicularis muscle to mobilize the flap. Transposition of the flap results in some kinking of the upper lid laterally, therefore, the flap is dissected from the superior crus of the lateral canthal tendon. Closure of the defect shows that the tension on the superior crux has been relieved. The tarsus is exposed on each side of the defect. Dissection is then carried out between the orbicularis muscle and the orbital septum. A 5-0 Vicryl suture is then placed partial thickness through the anterior surface of the tarsus. Two sutures are placed. Tying the suture opposes the tarsus well.
The eyelid margin is then closed with 7-0 Vicryl suture which is placed in a vertical mattress fashion. This will result in eversion of the eyelid margin. One suture is placed at the level of the Meibomian gland orifices. The other is placed at the level of the lash follicles. The orbicularis is closed with buried interrupted 5-0 Vicryl sutures. The skin is then closed with interrupted 7-0 Vicryl sutures. This results in a small dog ear inferiorly which is excised.
Attention is then directed to reconstruction of the lateral canthus. The orbicularis of the Tenzel flap is engaged with a 5-0 Vicryl suture which then engages the superior crux of the lateral canthal tendon. Tying the suture results in recreation of the lateral canthal angle. The canthotomy incision is closed with interrupted 7-0 Vicryl sutures. The anterior lamella of the Tenzel flap is then reassociated with the posterior lamella with 7-0 Vicryl sutures. At the conclusion of the case, antibiotic ointment is placed over the repair. The patient returns in one week for reevaluation.