Lateral Rotational Flap
This is Richard Allen at the University of Iowa. This video demonstrates repair of a lower eyelid anterior lamellar defect after Mohs excision of a basal cell carcinoma using a rotational flap laterally and a small advancement flap medially. A frost suture is placed. A subcilliary incision is extended from the lateral aspect of the defect to the lateral canthus. The incision is then extended superior and lateral to the lateral canthus following a rotational pattern. Medially, a subcilliary incision extends from the medial aspect of the defect to the level of the punctum. Dissection is then carried out between the orbicularis muscle and orbital septum to the inferior orbital rim. The dissection plane lateral to the lateral canthus is at the level of the subcutaneous fat. This is important so that dissection remains superficial to the branches of the facial nerve. Medial to the lateral orbital rim the dissection is carried out between the orbital septum and orbicularis muscle. As with almost all lower eyelid reconstructions, a lateral tarsal strip is often performed to stabilize the lid. The two advancement flaps are then mobilized to insure that there is not excessive tension with their closure. The lateral rotational flap is fixated to the periosteum of the lateral orbital rim with a 4-0 Vicryl suture. The two flaps are then sutured together with deep interrupted 5-0 vicryl sutures. The skin is then closed with interrupted 5-0 fast absorbing sutures. The subcilliary incision is closed with the same skin suture. Laterally, the skin is closed with 6-0 prolene suture. The Frost suture is removed and antibiotic ointment is placed over the repair.