Repair of defect involving the central brown and upper eyelid
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This is Richard Allen at the University of Iowa.
This video demonstrates repair of a Mohs defect which involves the upper eyelid and brow.
The patient also had a small defect laterally. An incision is made from the inferior edge of the defect extending both laterally and medially parallel to the contour of the upper lid crease. Dissection is then carried out between the orbicularis and orbital septum to widely undermine the area. In the area of the brow, dissection is carried out in the plane just beneath the brow fat. The goal is to close or decrease the size of the defect. Wide undermining of the area results in adequate mobilization of the tissue. Transposition of the flap shows that there is some tethering laterally which will be released with a small incision. Transposition of the flaps now shows that the defect can be closed. I apologize for the off-center nature of this portion of the video. Deep interrupted sutures are placed with buried 5-0 Vicryl sutures. The skin edges can then be closed along the eyelid with interrupted 6-0 Prolene sutures. Re-centering the video allows demonstration of placement of 5-0 Prolene sutures placed in a vertical mattress fashion in the area of the thick skin of the brow and forehead. This will result in eversion of the skin edge. There appears to minimal tension on the wound. The remainder of the repair is performed with the 6-0 Prolene suture. At the conclusion of the case, antibiotic ointment will be used three times per day. The patient will follow up in one week for reevaluation and suture removal.