Repair of canalicular laceration with a pigtail probe
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This is Richard Allen at the University of Iowa.
This video demonstrates repair of a lower lid canalicular laceration using a pigtail probe.
The lower punctum is dilated with the punctal dilator. The Bowman probe is then introduced and visualized medially, demonstrating the canalicular laceration. The upper punctum is dilated. A pigtail probe is then introduce into the upper punctum and rotated through the upper canaliculus, the common canaliculus, and out the cut end of the lower canaliculus. A 6-0 Nylon suture is then placed through the eye of the pigtail probe. The probe is then rotated back through the upper punctum and the nylon suture is left in position. A 25 mm piece of silicone tubing is then cut and the nylon suture is threaded through the silicone tube. A needle holder is placed over the silicone tube and the Nylon suture can now be pulled to pull the tube through the system. The pigtail probe is then placed through the lower punctum and the Nylon is again placed through the eye of the probe. The probe is rotated back through the lower punctum and the Nylon is then pulled to retrieve the tube through the lower punctum. The annular stent is now in position intubating the entire canalicular system. An additional needle holder is placed over the lower end of the silicone tube and the nylon suture is tied to complete the annular stent. The knot is then rotated to the area of the common canaliculus.
The canaliculus can then be repaired over the annular stent. This is performed by placing 7-0 Vicryl sutures in a pericanalicular fashion. The first suture is placed and left untied. Two to four sutures can be placed. In this case, a second suture is placed and then tied. Again these sutures are pericanalicular. The first suture can then be tied. This results in reannastomosis of the canaliculus over the annular stent. The skin can then be closed with the same 7-0 vicryl sutures. Sutures are placed through the eyelid margin as well. At the conclusion of the case, the stent appears to be in good position with minimal tension. The patient will use antibiotic ointment three times a day for a week. The stent will be removed in approximately 4 months.