Repair of upper eyelid defect with primary repair of posterior lamella and full-thickness skin graft
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This is Richard Allen at the University of Iowa.
This video demonstrates repair of a full-thickness upper eyelid defect with a combination of a wedge repair of the posterior lamellar defect followed by a full-thickness skin graft to repair the anterior lamellar defect.
Examination of the defect shows the extent of the posterior lamella that remains. Although the defect of the posterior lamella appears to be 50% of the eyelid, there appears to be enough eyelid laxity to allow primary repair of the posterior lamella. A 5-0 Vicryl suture is placed partial thickness through the posterior lamella on each side of the defect. An additional suture is then placed which allows repositioning of the tarsus. The eyelid margin is then repaired with a 7-0 Vicryl suture placed in a vertical mattress fashion. This results in eversion of the eyelid margin at the repair to prevent a subsequent notch. The posterior lamella is now repaired.
Attention is directed to the remaining anterior lamellar defect. Telfa is used to make a template of the defect. The template is transferred to the retroauricular area where a full-thickness skin graft is harvested.
The graft is placed into position and appears to cover the defect adequately. A 5-0 fast absorbing suture is used to fixate the graft into position at its edges. At the margin of the eyelid, the graft is sutured to the tarsus with a 7-0 Vicryl suture. The 7-0 Vicryl is used in this area to take advantage of the smaller needle. The remainder of the graft is then sutured into position with a combination of interrupted and running 5-0 fast absorbing sutures. The lid margin portion of the repair is then completed.
6-0 Silk sutures are then placed, which will fixate the bolster into position. Inferiorly, the sutures are used to perform a temporary tarsorrhaphy as well so that the bolster does not irritate the eye. The sutures are cut long. Antibiotic ointment is placed over the graft followed by the Telfa. A bolster fashioned from a scrub sponge is then fixated into position with the 6-0 silk sutures. An eye pad will then be placed. The patient will return in approximately one week for removal of the patch and bolster.