Hard Palate Graft Harvest
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This is Richard Allen at the University of Iowa. This video demonstrates the harvesting of hard palate to be used in the correction of lower lid retraction. Lidocaine with epinephrine is injected into the area of the hard palate. This will be a bilateral procedure. A 15 blade is then used to make an incision through the mucosa of the hard palate to the underlying fat layer. The incision extends from the junction of the hard and soft palate posteriorly to the rugae anteriorly. The incision is lateral to the gentle sloping from the molars. Medially, it is lateral to the midline. The 15 blade is then used to harvest the palate. The layer used is where you just see the underlying fat layer. This is performed along the length of the palate to the area of the junction of the hard and soft palate. A right angled blade is then used to complete the harvesting. Hemostasis is obtained with the unipolar cautery. Surgicel is then placed to aid in hemostasis. Attention is then directed to the opposite side where the harvest is performed in the same manner. One of the grafts will be stored in the tissue bank, as the patient's eyelid will be placed on stretch with a Frost suture post-operatively and therefore the eyelid portion of the procedure will be unilateral. Again, hemostasis is obtained with monopolar cautery followed by Surgicel. A splint/protector for the palate is placed. This is very useful to keep the patient comfortable post-operatively so that they can eat without significant pain. It is usually removed after a week.