Repair of cicatricial entropion with Quickert sutures, tarsal fracture, and lateral tarsal strip
Richard C. Allen, MD, PhD
Additional Notes: Length 04:22
This is Richard Allen at the University of Iowa. This video demonstrates repair of a cicatricial entropion using a combination of a lateral tarsal strip, Quickert sutures, and a tarsal fracture. A lateral canthotomy and inferior cantholysis are performed with the needle tip cautery. Quickert sutures will then be placed. This is performed with a double-armed 5–0 Vicryl suture which is placed through the fornix, which then engages the retractors, and then exits out just inferior to the lash follicles. Approximately 3 sutures are placed in the exact same manner. Again, deep in the fornix with engagement of the retractors and then exiting at the area just inferior to the lash follicles. Dissection is then carried out between the anterior and posterior lamella laterally to fashion the lateral tarsal strip. The mucocutaneous junction is excised with Westcott scissors. The posterior surface of the posterior lamella is scraped with a 15 blade.
The 15 blade is then used to make a tarsotomy. This is approximate 2 millimeters inferior to the lid margin. This tarsotomy is then completed with Westcott scissors. The 5–0 Vicryl suture is then placed at the lash follicles to exit at the incision in the tarsus. The suture then engages the cut surface of the inferior portion of the tarsus. The suture then exits adjacent to the entry site. Tightening the suture will result in eversion of the eyelid margin. Again the suture is placed through the area right at the eyelash follicles. It then engages the cut surface of the tarsus. The suture is then placed back through the incision to exit at the lash follicles. Approximately four to five sutures are placed along the length of the eyelid. The sutures are tied in order to evert the eyelid margin.
The lateral tarsal strip is then engaged with 4-0 Mersilene sutures. This is a double-armed 4-0 Mersilene suture on an S2 needle. The suture then engages the lateral orbital rim at the level of Whitnall's tubercle. The suture is tightened and the position of the eyelid is inspected which appears to be adequate. The suture is then tied. Attention is then directed to the Quickert sutures which are tied. Therefore, this procedure results in horizontal tightening of the eyelid, tightening of the retractors, and eversion of the lid margin. The anterior lamella is then re-associated with the posterior lamella along lateral tarsal strip. The lateral canthotomy is then closed with interrupted 5-0 fast-absorbing sutures. At the conclusion of the case, the eyelid appears be in good position. The patient will use erythromycin ophthalmic ointment 3 times a day and return in approximately 1-2 weeks for suture removal.
If video fails to load, use this link: https://vimeo.com/205005840