University of Iowa Health Care

Ophthalmology and Visual Sciences

Combination Mustarde and glabellar flap

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This is Richard Allen at the University of Iowa.  This video demonstrates repair of a deep medial canthal defect which straddles the medial canthal tendon with a combination Mustarde and glabellar flap.  The patient is status post excision of a basal cell carcinoma which has also resulted in an upper and lower canalicular defect.  The canalicular defects are examined and a Crawford stent is placed through the lacrimal system and retrieved from the nose.  A 4-0 Vicryl suture will be used to recreate the canthal angle by engaging the periosteum of the posterior lacrimal crest followed by the medial portion of the defect along the eyelid.  This is performed for both the upper and lower eyelid and the canaliculus is repaired over the stent with interrupted 7-0 vicryl sutures.  This results in repair of the upper and lower canalicular defect with the stent in good position. The glabellar flap is then developed.   A 15 blade is used to make an incision along the marking.  This flap will cover the thicker skin of the defect. Dissection is performed in the plane beneath the subcutaneous fat.   It is transposed into position.  The donor site is closed with deep interrupted 4-0 vicryl sutures.  A deep bite is place to secure the flap into the bed of the defect.  The flap is trimmed to respect the different skin types, and a 5-0 Prolene suture is used to close the skin of the donor site.  These sutures are placed in a vertical mattress fashion.  The remaining portion of the flap is sutured with interrupted 6-0 prolene sutures.  The inferior portion of the defect corresponding to the thinner skin will then be repaired with a Mustarde rotational flap.  A subciliary incision is made with the monopolar cautery extending from the defect medially to the lateral canthus laterally. Lateral to the lateral canthus the incision is continued in a superior and lateral direction.  Dissection is carried out between the orbicularis muscle and orbital septum.  Lateral to the lateral orbital rim the dissection is carried out in a plane just beneath the subcutaneous fat.  The rotation of the flap shows that it is adequate to close the defect.  This is placed into position with deep interrupted 5-0 Vicryl sutures.  The subcilliary incision is closed with a running 5-0 fast absorbing suture.  The lateral portion of the flap is closed with deep interrupted 5-0 vicryl sutures to support the flap laterally followed by interrupted 6-0 prolene sutures.  A lateral tarsal strip is not performed in this case since the lid was tightened horizontally from the repair of the canaliculus.  The glabellar flap is then sutured to the Mustarde flap with interrupted 5-0 fast absorbing sutures.  At the conclusion of the case the defect is closed with minimal tension with the lid in good positon and the skin types respected.   The patient returns in one week for suture removal. 

2000, 2015
last updated: 09/01/2015
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