This is Richard Allen at the University of Iowa. This video demonstrates repair of a lateral canthal/upper eyelid defect with combination of a lateral rotational flap and full-thickness skin graft. A rotational flap is planned. This will cover the lateral portion of the defect which does not cover the eyelid. This is performed so that the eyelid skin can be replaced with a thinner skin graft. Dissection is carried out in the plane of subcutaneous fat. Wide undermining is then performed. The flap is then sutured into position with deep interrupted 4–0 Vicryl sutures. A template of the resulting defect is then made. A lateral canthopexy will be performed with a 5–0 Prolene suture. This is placed through the lateral canthal angle followed by the periosteum of the superior lateral orbital rim. This will result in support of the lateral canthal angle. Inferiorly, the defect will be attempted to be made smaller by elevating the lateral midface with a 4–0 Vicryl suture which engages the periosteum of the lateral orbital rim. The template is then again placed into position and is trimmed. The flap is then closed with deep interrupted 4–0 Vicryl sutures followed by interrupted 5–0 Prolene sutures. The graft is then harvested from the retroauricular area. Unfortunately, there is a small buttonhole in the graft. The graft is sutured into position with interrupted 5-0 fast-absorbing sutures. 6-0 silk sutures are placed for bolster fixation. Erythromycin ophthalmic ointment is placed over the graft. A bolster of Telfa and foam is placed and fixated into position with the 6-0 silk sutures. The patient will return in one week for bolster removal and reevaluation.
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