Repair lower lid defect with cantholysis
This is Richard Allen at the University of Iowa. This video demonstrates repair of a lower eyelid defect using direct closure following a cantholysis.
The edges of the defect are freshened and squared off with a 15 blade.
Reapproximating the wound edges shows the wound to be at significant tension. Therefore, an internal inferior cantholysis is performed with the Colorado needle.
In this case, a concurrent canthotomy is not performed. This results in release of the lateral lower lid and lessens the tension at the proposed wound closure.
The defect can now be closed as in a wedge resection.
A 5-0 Vicryl suture is placed partial thickness through the anterior surface of the tarsus. Two such sutures are placed.
These sutures are then tied which reapproximates the eyelid margin.
The eyelid margin is then repaired with interrupted 7-0 Vicryl sutures.
These are placed in a vertical mattress fashion to evert the wound edge.
One suture is placed at the level of the meibomian gland orifices and an additional suture is placed at the level of the lash follicles.
This results in repair of both the anterior and posterior lamella of the lid margin.
As we can see here, there is good eversion of the lid margin which will prevent subsequent notching.
The skin can be closed with the 7-0 Vicryl suture or your desired skin suture.
A small Burrows triangle is excised inferiorly to prevent a standing cone deformity.
At the end of the case the lid margin appears to be well apposed and everted and there is minimal vertical tension on the lower eyelid.