Fasanella Servat procedure
This is Richard Allen at the University of Iowa.
This video demonstrates the Fasanella Servat procedure. 4-0 silk suture is placed through the eyelid margin for a traction suture.
The eyelid is everted over a Desmarres retractor. Additional local anesthesia is placed transconjunctivally.
It is determined that a 3 mm tarsal resection and a 3 mm conjunctival and mullers muscle resection will be performed. These marks are made with the monopolar cautery corresponding to the central third of the eyelid.
Tooth forceps are then used to grasp the superior border of the tarsus. A 4-0 silk traction suture is then placed at the superior boarder of the tarsus in a locking running fashion.
The traction suture then holds the eyelid in position and in this case curved hemostats are used to clamp at the previous markings on the tarsus.
A Putterman clamp can be used here as well which is probably more efficient.
A 6-0 chromic suture is then placed in a running mattress fashion on the other side of the curved hemostats.
This suture is placed across the eyelid and then turned around to complete the passes. There is significant discussion around the most appropriate suture to use as well as whether to place these sutures transcutaneous.
The 15 blade is then used to make metal on metal contact with the curved hemostats to excise the tissue.
The tissue is removed and the suture is tied.
Since the knot is on the inside of the eyelid, a contact lens will be placed later.
Inspection of the resected tissues shows the tarsus as well as the conjunctiva and mullers muscle.
Measurement of this shows an approximate height of 6-7 mm.
The contact lens is placed, the traction sutures are removed, and antibiotic drops are placed into the eye.